How Much Coverage Does Health Insurance Actually Offer?

If you live in the United States and you want to receive adequate health care, it’s no secret that you need to have health insurance. While you can certainly receive health care without insurance, it’s going to come at a price; and you can expect that price to be very high. Given the fact that the cost of medical care is rising at an unprecedented rate, having health insurance is more important now than it has ever been before; if you aren’t insured, getting treated for something as minor as a scrape can end up costing you thousands of dollars.

But, the health insurance industry is constantly changing. In 2010, with the passage of the Affordable Care Act (ACA or “Obamacare”) the aim of which was to ensure that all Americans had access to insurance, more people were insured than ever; but, due to legislation that has altered the ACA, things have changed in the few short years since the policy was enacted. As such, many people are left wondering what their health insurance covers and what it doesn’t; or how much coverage their health insurance actually provides.

It’s important to have a thorough understanding of your health insurance and what it covers so that you aren’t hit with unexpected medical bills. To help you gain a better understanding of your insurance and what type of coverage it offers, keep on reading to learn more.

How Does Health Insurance Work?

To understand how much coverage your plan provides, it’s first important to understand how health insurance works.

Health insurance is an agreement that is made between the insured (you) and the insurer (the company that issues your insurance policy). There are several health insurance companies in the United States, and each one offers several different policies. Not all policies offer the same type of coverage; therefore, it’s important that you familiarize yourself with your specific plan.

Your health insurance policy will provide you with what is referred to as an “explanation of benefits”, which explains what your plan covers. Your policy’s explanation of benefits will list things such as medical treatments, medications, and diagnostic tests that it covers. Your insurance company covers the cost of the benefits that are listed in the explanation of benefits; these benefits are described as “covered services”

In addition to listing what it covers, your policy will also list things that it doesn’t cover. Any services that are not covered by your policy, you will have to assume full financial responsibility for. In other words, if you have a specific type of MRI performed and it is not covered by your insurance policy, you will need to pay the total cost of the bill out of your own pocket.

Are There Any Costs to You?

Of course, you will be required to pay for any services that you receive that aren’t covered by your health insurance plan. However, you’re probably wondering if you will have to pay any amount for the services that your policy does cover. Generally speaking, yes, you will need to pay a portion of the services you receive, even if they are covered.

Firstly, you’ll need to meet your deductible before your health insurance will kick in. Your deductible is the amount that you have agreed to pay before your insurance company will take over and pay for your medical care; you will have to pay your deductible each year. Once you’ve met your deductible, your health plan will kick in; but, you will likely still be required to cover some expenses in the form of co-pays or coinsurance. For example, even if you have met your annual deductible and you are receiving a covered service, you will likely still have to pay for a co-pay before a medical service is provided. The cost of co-pays vary.

Are There Any Services You Won’t Have to Pay Anything For?

There are. Every health insurance plan offers what is referred to as “essential health benefits”. As the name suggests, these benefits cover things that are deemed medically essential; vaccinations and screenings for certain health conditions, for example.

If you purchase a health insurance plan via the Health Insurance Marketplace (ACA), your policy will cover preventative services, as well as a minimum of 10 benefits that are considered essential, such as emergency services, hospitalization, pre-natal and newborn care, etc.

If your policy is issued by your employer, the coverage that it provides may differ from the coverage that plans offered under the ACA covers.

How to Find Out What Your Policy Covers

Whether you have employer-sponsored health insurance or you have a Marketplace plan, the best way to find out what is and is not covered by your policy is by contacting your health insurance company directly. Make sure you ask for a list of benefits so that you have a hard copy to refer to. If you are unsure about your coverage, always ask. It’s far better to know exactly what is and isn’t covered before receiving service so that you can avoid being hit with an unexpected – and expensive – bill.