Health Insurance Explained For United States of America

 

Millions of us now have health insurance under the Affordable Care Act or what some people call Obamacare but like many things in life your health insurance can often be confusing and complicated whether you've been insured for years or you're new to the game understanding your policy is important to your health and your wallet.

First you have to pay your premium every month or your insurance could get cancelled kind of like your cable subscription you can also think of it like a shared healthcare piggy bank we all chip in each month even if we're healthy so the money is there when we need it.

If you get insurance at work your employer probably pays most of your premium and the rest comes out of your paycheck automatically. If you have Medicaid you most likely don't have to pay any premium at all the federal government and your state take care of that.

If you're insured through a new health insurance marketplace depending on your income you may be eligible for a tax credit that pays a portion of your premium once you have that shiny new insurance card you'll want to try really hard to keep it in your wallet to better your odds of staying healthy be sure to take advantage of the free preventive services that all new insurance plans provide but of course stuff happens and that's when insurance really comes in handy now having insurance helps a lot. But it doesn't mean all your health care is going to be free there are lots of details about your insurance plan that affect how much you pay when you get sick or injured. If you have Medicaid a lot of these services could very well be free otherwise you'll likely have to pay something when you go to the doctor or fill a prescription this is called a copay when it's a specific dollar amount like dollars per visit or coinsurance if it's a percentage of the bill.

 

There's also the deductible that's how much comes out of your own pocket before your insurance starts paying depending on your plan you might have a deductible for all your care or it might only apply to some types of care like hospital stays and prescriptions so read your plan material because it could add up to thousands of dollars another important part of your plan is the out-of-pocket maximum this is the most you'll ever have to pay in any one year at least for the benefits your plan covers your insurer will pay a hundred percent of anything beyond the maximum for the rest of the year it can be just as confusing dealing with prescriptions your plan has a list of drugs it will pay for called a formulary.

But the prices vary check with your doctor or pharmacist because a generic drug might fix you up the same as a brand name drug but the price difference could be huge so those are the costs typically involved but remember that they'll be affected by your insurance plan's provider network this is a list of doctors and hospitals that are connected to your plan insurance companies negotiate discounts with these providers stay in network and the discounts get passed to you go out of network and you could end up paying full price and remember that out of pocket limit it won't work if you go out of network in some plans like HMOs or EPOs your insurance would pay nothing. If you go out of network in other plans like PPOs your insurance will cover you no matter where you go but you'll pay a lot more if you go out of network also.

 If you want to visit a specialist like an orthopedist some plans require a referral from your primary care doctor sound easy enough well sometimes staying in network can be tricky in a hospital it's possible that your surgeon could be in network while your anesthesiologist is not if this happens to you don't be afraid to negotiate with your provider or file an appeal with your insurer so as you can see there's a lot to think about when you choose an insurance plan each year some plans may have low premiums but fewer doctors are hospitals and high deductibles there are trade-offs and understanding and choosing among plans isn't always easy remember if you have questions call your health plan and ask or check with your hospital or doctor if you still have questions your state insurance department or consumer assistance program can help with the Affordable Care Act there's new support for consumers so take advantage of it having health insurance protection is a good thing especially when you know how it works we hope you're now better prepared for the next time you have to pull that insurance card out of your wallet.