Why is health coverage important?
Everybody will need a doctor or hospital at some point in life and no one can predict when they will get sick or have an accident. When that day arrives, the cost of health care could be financially devastating for a person who is not enrolled in health coverage. With the average cost of a three-day hospital stay priced at $30,000, it doesn’t make sense to take the gamble of going without health coverage, particularly if you can find it at an affordable price through the Marketplace.
Health coverage can also help keep you and your family healthy. If you have coverage, you’ll be able to get preventative care (like regular check-ups and screenings) so you and your family will be sick less often.
What does health insurance cover?
Today, there is a wide range of health insurance policies offering different benefits and access to different doctors, hospitals, or other providers. The federal Affordable Care Act requires that all health plans offered in the individual and small group markets must provide a comprehensive package of items and services, known as Essential Health Benefits.
These benefits fit into the following 10 categories:
- Ambulatory patient services
- Emergency services
- Hospitalization
- Pregnancy, maternity, and newborn care
- Mental health and substance use disorder services, including behavioral health treatment
- Prescription drugs
- Rehabilitative and habilitative services and devices
- Laboratory services
- Preventive and wellness services and chronic disease management
- Pediatric services, including dental and vision care
In addition, plans must now offer birth control coverage and breastfeeding coverage.
How does health insurance coverage work?
When you have insurance, you pay some costs and your insurance plan pays the rest:
- 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 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. Many plans provide preventive services, and sometimes other care, before you’ve met your deductible.
- Copayment 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.
- Coinsurance 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.