Health Insurance

Request-Quote-ButtonHealth care is something all of us need at some point. No one likes getting sick or hurt. Having health insurance will pay for preventive services and a part of the cost when you’re sick or hurt—sometimes a big part.

The Basics

Health insurance is a contract between you and an insurance company. You buy a health plan from the insurance company. They agree to pay some of your medical costs, such as doctor or hospital visits, prescription drugs, tests, maternity care and other medical services you may need.

It protects you from high costs when you need medical care, especially for ongoing health conditions and unexpected illnesses or injuries from an accident. Most health plans also include preventive services to help you be healthy, like annual checkups, mammograms, and vaccines at no extra cost.

So how exactly does it work?

After you enroll, you pay a monthly bill to keep your health plan. This is called a premium. If the government helps pay part of your premium, this is called a subsidy, and they send that portion directly to the health insurance company. Most health insurance companies will have a list of doctors, hospitals and other health care providers that you can choose from, called in-network health care providers. Receiving services from these health care providers will generally save you the most money . There are some plans, such as HMO coverage, that only cover services you receive in-network, and other plans that require that you use exclusive providers for certain services, such as prescription drugs or medical equipment.

Definitions:

Co-pay – For some health care services you’ll pay a flat fee, usually at the time you receive the care.

Deductible – The dollar amount that you must pay each year before insurance begins to pay for certain health care services. You pay the plan deductible first, then coinsurance (%) may apply.

Coinsurance – The percentage (%) you may pay for services after you meet the deductible.

Out-of-Pocket Maximum – This is the most you pay for covered health care services during the calendar year. Most of your covered expenses go toward this maximum. Once you reach the maximum, your plan pays 100% for covered services.

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