To obtain health insurance you have two options. First and the most common option is that the employer you work for will offer it as a benefit for working at the company full-time. If you are currently self-employed, retired, unable to work or don’t work at a company, then you can receive healthcare benefits either through the marketplace or through government-funded programs such as Medicare, Medicaid, or CHIP.
One of the hardest parts of health insurance is understanding the inner workings of each plan. If you are in a managed care insurance plan you will need to go to a care provider in your network in order to receive coverage for any services. Going outside of these networks can result in higher copays and even the insurance company refusing to pay for the medical services or drugs. In these HMO plans, you will also choose a primary physician who will guide your care and give you referrals to go see specialists. For those in the similar PPO plan, you will have more flexibility to go outside of the network at slightly higher costs and still receive coverage.
There are some instances where you may need to get preauthorization before getting certain care. Insurance companies can deny coverage for these costs if the proper steps are not followed. Also, some insurance companies will refuse to cover name-brand drugs if there is a generic version available at a lower price. Rules like these will be stated in your initial meeting with an agent and should be available for you to read in the material they send you home with.
It is important to note that most insurance plans will come with some type of fee you still need to pay. This could be in the form of co-pays for services, deductibles you must meet or even paying a percentage of the cost through coinsurance. Plans that feature higher out-of-pocket costs will normally have smaller monthly premiums with a low deductible.
High-deductible health plans are quickly gaining popularity as they feature lower premiums and low deductibles when compared to other options. By choosing this plan, you also have the option to open a health savings account where you can contribute pre-tax income to pay for qualifying medical expenses.