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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 you and your 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.

Health insurance protects you from the unexpected

An average one-day hospital stay is *$2,212. 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 after you've met your deductible. For example, after meeting your deductible you may pay $25 for a visit to the doctor's office that would cost $150 if you didn't have coverage. The health plan pays the rest.
  • Co-insurance: Co-insurance is similar to co-payment, 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.

How insurance protects you insurance coverage from high medical costs:

  • 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 co-payments 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.

Don’t let that happen to you. For more information visit www.healthcare.gov

*2014 Kaiser Foundation