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What You Need to Know About Health Insurance


What You Need to Know About Health Insurance

Accidents and illnesses can happen to anyone at any time. No one plans to get sick or hurt, but most people need medical care at some point. Health insurance covers these costs and protects you from very high expenses.

Health coverage when you need care

Simply put, health insurance is a contract between you and your insurance company. You buy a plan, and the company agrees to pay part of your medical costs when you get sick or hurt. However, it’s not really that simple. You need to consider what is right for your and our family, your out-of-pocket costs and your monthly premium.

Under the Affordable Care Act, plans available in the Marketplace (and most other plans) provide free preventive care, like vaccines, screenings, and check-ups. They also cover some costs for prescription drugs.

When and how to enroll in plans for 2017

Open enrollment starts November 1 for 2017

  • Enroll by December 15th for an effective date of January 1st
  • Enroll by December 16h through January 15th for an effective date of February 1st
  • Enroll by January 16th through January 31st for an effective date of March 1st.

You will need a life qualifying event (loss of coverage, a new dependent, permanent move to Florida, marriage or divorce) within 60 days of the event to enroll before November 1st or after January 31st.

Health insurance protects you from the unexpected

An average one-day hospital stay is *$1,900. Most of us can’t afford even one day at the hospital without having it impact our financial stability. Health coverage can help protect you from high, unexpected costs like these.

How health insurance coverage works

  • Premium: A premium is a fixed amount you pay to your insurance plan, usually every month. You pay this even if you don't use medical care that month.
  • Deductible: If you need medical care, a deductible is the amount you pay for care before the insurance company starts to pay its share. Once you meet your deductible, your insurance company begins to cover some costs of your care. Some plans have lower deductibles, like $250. Some have higher deductibles, like $2000.
  • Co-payment: A co-payment is a fixed amount you'll pay for a medical service not subject to your chosen deductible. For example, you may pay $25 for a visit to the doctor's office that would cost $150 if you didn't have coverage or a copay benefit. The health plan pays the rest.
  • Co-insurance: Co-insurance is similar to copayment, except it's a percentage of costs you pay. For instance, you may pay 20% of the cost of a $100 medical bill. So you would pay $20 and the health plan would pay the rest after you have paid your calendar year deductible

Insurance coverage protects you from high medical costs two ways:

  • Out-of-pocket maximum: This is the total amount you'll have to pay if you get sick. For example, if your plan has a $3000 out-of-pocket maximum, once you pay $3000 in deductibles, coinsurance, and copayments the plan will pay for any covered care above that amount for the rest of the year.
  • No yearly or lifetime limits: Health plans in the Marketplace can't put dollar limits on how much they will spend each year or during your lifetime to cover essential health benefits. After you've reached your out-of-pocket maximum, your insurance company must pay for all of your covered medical care with no limit.

Going without health insurance can put you in serious financial risk. It is important to consider your options. Keep in mind that if you or someone in your family suffers from an illness or accident this can sometimes lead people without coverage into deep debt or even into bankruptcy.

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*2010 Kaiser Family Foundation