Health Insurance 101: Your Complete Guide to Health Insurance

Health Insurance 101: Your Complete Guide to Health Insurance

Currently, the average cost of health insurance coverage in the U.S. is about $452 per month. While this may seem like a large figure, uninsured Americans face even tougher challenges when it comes to access to healthcare. Specifically, they receive poor quality medical care and lack access to recommended care, which often result in the worst outcomes, according to the National Center for Biotechnology Information (NCBI). This essentially means that health insurance coverage is vital. Here’s a comprehensive guide to health insurance.

What Is Health Insurance?

As the name implies, health insurance refers to a policy that covers your healthcare costs, including, among others, prescription drugs, surgical expenses, and dental expenses. It typically saves you from paying for medical expenses out of pocket and gives you access to better healthcare.

Types of Health Insurance Coverages

There are different types of health insurance coverages. The type you choose should depend on what you want to cover, your age, employment status, and financial stability. Common health insurance coverages include:

    • Medicare

      This is a federal government health insurance program that caters to healthcare expenses for senior citizens, younger disabled citizens, and those with End-Stage Renal Disease (ESRD). Medicare comes in four parts (A, B, C, and D), with each part covering specific aspects of healthcare. For instance, Medicare part A covers hospice care, inpatient hospital stays, some home healthcare services, and skilled nursing care.

    • Employer-sponsored

      Also known as group insurance, employer-based health insurance is the policy you get through your employer. Here, the employer pays at least 50% of the premiums, leaving you with a smaller portion to pay. For instance, in March 2020, U.S. employers paid an average of 67% of health insurance premiums for their employees, per the U.S. Bureau of Labor Statistics (BLS).

    • Short-term

      This is a temporary health insurance coverage that you purchase to bridge gaps in your primary health insurance policy.

    • Individual and family plans

      These are health insurance plans available through the federal government, private insurance companies, as well as insurance brokers. They are also known as Affordable Care Act (ACA) policies or Obamacare.

    • Dental insurance

      Considering most health insurance plans exclude dental care, a separate dental insurance policy is necessary to pay for your dental care needs.

    • Vision insurance

      This policy covers eye care costs.

Categories of Health Insurance Coverage Plans

Apart from the coverage type, you also need to choose a suitable health insurance plan from the following categories:

    • Health Maintenance Organization (HMO)

      This plan provides coverage through a network of healthcare providers. As such, you can only receive medical care from specific doctors and healthcare institutions. With HMO, you will seek services from a primary doctor, and only access services from other specialists upon referral from this doctor.

    • High-Deductible Health Plans

      As the name implies, this plan allows you to pay a higher deductible than traditional plans in exchange for lower premiums.

    • Preferred Provider Organizations (PPO)

      This plan is similar to HMO, only that it gives you the freedom to choose a healthcare provider outside the network. Also, it doesn’t require a referral from your primary doctor in case you want to see a specialist.

    • Point-of-Service Plans

      This plan combines the features of PPO and HMO.

    • Exclusive Provider Organizations (EPO)

      This plan only covers the healthcare costs if you go to healthcare providers within the network, except for emergency cases.

Take note that health insurance plans also come in metal levels, including bronze, silver, gold, and platinum which typically cover 60%, 70%, 80%, and 90% of the healthcare costs, respectively. This means that you are supposed to pay any outstanding costs out of pocket. There is also a catastrophic coverage option, which provides coverage in the worst-case scenarios. Those under 30 years of age as well as those eligible for “hardship exemption,” can access this plan at low premiums. Even so, it has high deductibles.

Factors Influencing Health Insurance Costs

Typically, the cost of health insurance coverage varies depending on the type of plan, amount of coverage, as well as insurance provider. That said, here is a look at other factors that may affect the insurance costs, as per the Centers for Medicare and Medicaid Services (CMS)

    • Age

      As you grow older, insurance providers will likely charge you higher health insurance premiums, citing high risk.

    • Tobacco use

      Smokers are prone to diseases such as stroke, lung diseases, cancer, heart disease, diabetes, tuberculosis, certain eye diseases, and bronchitis, according to the Centers for Disease Control and Prevention (CDC). As such, insurance companies consider them high-risk, and hence, charge them higher premiums.

    • Location

      The cost of health insurance varies by state and location due to local regulations, competition, and the cost of living.

Tips to Lower Your Healthcare Costs

Use these tips to lower your health insurance costs:

  • Adopt a healthy lifestyle
  • Opt for generic medications
  • Choose the right health insurance plan
  • Opt for outpatient facilities
  • Stick to healthcare providers within the network of your health insurance plan
  • Plan ahead for emergencies
  • Go for regular check-ups

Use the information in this guide to find the right health insurance plan. If you need more help concerning Medicare health insurance in Las Vegas, Pahrump, or Henderson, don’t hesitate to contact Medicare Advisors. Our experts are ready to take you through the available coverage plans and help you register within the required period.