How health insurance works

Health insurance is one of the best ways you can protect yourself and your family in case you get sick or injured and need medical care.

Some people receive insurance from their employers, other purchase insurance directly. When you buy health insurance, you pay a fixed amount for the insurance (sometimes, that is zero) and for “deductibles.” Deductibles are the amounts that you may have to pay before insurance pays for anything. You also might have “co-pays,” which are an amount you pay whenever you go to the doctor or hospital.  But after that, insurance pays for pretty much everything else when you see a health care provider, and that can add up quickly.

Insurance helps you get the regular medical and dental care you need to stay healthy. Because check-ups in a doctor’s office or community clinic often are completely covered by your insurance, you don’t have to put them off.  And it is never a good use of time or money to go to the emergency room for everyday health needs, because that can be expensive and mean long waits.

Thanks to the Affordable Care Act (ACA), millions of people can now afford health insurance. Many more people are eligible for public insurance, called Medicaid (the name is different for children and in some states), than ever before. And for those who are not, the least expensive private plans cost nothing.

There is a lot of talk that ACA may be changed someday. But for now, it remains the law. That means that all insurance plans must cover pre-existing conditions, must include mental health benefits, cannot cut people off when they get sick, and can’t impose annual or lifetime caps on benefits. 

However, one of the most important things to keep in mind about your insurance is this. Your doctor or other providers may not accept the insurance plan you have. So, you need to ask about this before you start treatment, because it may affect how much you must pay.  It may also help you to decide whether to change your insurance plan the next time you can.

It can be tricky to understand your health insurance.

Learn more about insurance here.