Health Insurance Overview
Health insurance has received much attention in the US recently, with major healthcare legislation signed into law on March of 2010 that will change many aspects of health insurance in the country. The central focus of health insurance, however – insuring that you and your family can pay for medical costs for regular medical check-ups or catastrophic, health-related events – should remain unchanged.
Health Insurance Basics
Health insurance is similar to most other forms of insurance: You pay a monthly fee to be assured that when you need healthcare it will be available to you at a reasonable cost. These monthly fees are called Premiums and they vary from person from person, and from health plan to health plan (see Health Insurance Rates and Health Insurance Plans for more information). Other common features surrounding health plans include:
Co-Payments: A fee patrons must pay (usually under $100) for each medical appointment and procedure.
Deductibles: The amount of money patrons must pay before their health insurance will pay for the rest.
Explanation of Benefits: A description (usually in letter form) explaining the amount of money the health insurance provider will pay for a medical expense.
Other, Complicating Factors
While health insurance seems straight forward (pay a small, monthly payment, and get that money back in expenses paid when you or other family members get sick), there are other factors that can complicate matters. For example, some health insurance plans have exclusions, certain, defined medical services (like dental care, purchasing of band-aids, etc.) that they don’t pay for. Health insurance providers can also deny individuals with pre-existing conditions.
Other plans have coverage limits (caps on the amount of money health insurance companies will pay), in-network providers (pre-approved medical professionals the health insurance provider usually works with), and prior authorization requirements (requiring patrons to seek permission for specific medical procedures before having them performed).
Health Insurance in America
Health insurance is different in the US than in other industrialized countries, which feature universal, government-administered health insurance. The majority of Americans (~67 percent) have insurance through their jobs, spouse, parent, or purchase insurance individually. Nearly 28 percent of individuals in the United States receive some form of health insurance from the government, through programs like Medicare (for seniors and certain disabled individuals) or Medicaid (for children and families with low income). This leaves around 45 million Americans with no health insurance.