What Are Basic Things You Should Know About Health Insurance?
Before you pick an insurance plan for yourself, you should first know the key features that determine how much you’re going to pay for the health services. The following are the key features, explained in as simplified manner as possible:
- Premium: this refers to the amount you pay every month to a health insurance company for your health insurance plan.
- Health insurance deductible: this is the amount you have to pay for covered services before your insurance takes effect.
- Out-of-Pocket Maximum/Limit: this is the amount you need to pay for services in a year. It’s when you spend this amount that your insurance plan pays all of your healthcare costs.
- Co-payment or “copay”: this refers to the fixed amount that you pay for a service or medication after you’ve paid the deductible.
- Coinsurance: this is similar to copayment, except that coinsurance isn’t a fixed cost. Instead, it’s a percentage of the price that you have to pay.
What Are the 10 Essential Benefits that All Insurance Plans Must Provide?
In 2010, the Affordable Care Act — more commonly known as Obamacare — was enacted, and this law requires all healthcare insurance plans to cover certain healthcare services. These services are:
- Emergency services
- Laboratory services
- Pediatric services
- Mental health services
- Ambulatory patient services (outpatient care)
- Preventive and wellness services
- Rehabilitative services and devices
- Maternity and newborn care
- Hospitalization
- Prescription drugs
Please note that these are categories and that specific services under these categories may vary depending on the state.
What Type of Health Insurance Should You Buy?
Health insurance can be categorized into two general types — public and private — and under these two, there are several types of insurance plans. Public health insurance includes the CHIP, Medicaid, and Medicare. These are all federal and state health insurance programs for Americans who are age 65 and above (Medicare), low-income families and individuals (Medicaid), and children below the age of 18 (CHIP).
Meanwhile, private health insurance is usually purchased through a marketplace or is provided by an employer. The plans under this kind of health insurance can vary from each other significantly.
What Are the Metal Tiers?
As mentioned earlier, all insurance plans would require you to split the costs with the company. And the quick way to classify the insurance plans based on the split used is by using the metal tiers.
| Metal Tiers | Your Share | Insurer’s Share |
| Bronze | 40% | 60% |
| Silver | 30% | 70% |
| Gold | 20% | 80% |
| Platinum | 10% | 90% |
Do take note that the percentages don’t include premiums. Additionally, the metal tiers don’t correspond to the exact amount you’ll pay for the health services.
Conclusion
Nowadays, it’s ideal that we should have health insurance because healthcare can be quite costly if we pay it ourselves. But health insurance is one complicated subject matter, so it can be challenging to understand it fully.
The above, are some of the most constantly asked questions when you start choosing a health insurance plan. The answers provided are simplified — health insurance concepts are complicated — but they are enough to show you the basics of how health insurance works.
Please read the questions and the answers carefully, and continue researching health insurance to understand it better and help you decide how to pick the right plan for you.
