Today, health insurance is one of the top issues affecting the quality of life. According to the Centers for Disease Control (CDC), over 32 million Americans under age 65 are uninsured in 2021. Getting health coverage in Bristol, CT, should be a priority for people of all ages who are currently uninsured. Here are a few common questions and answers about medical plans to guide you in your health insurance choices.
What Is Health Insurance and Why Is It Important?
Health insurance plans are divided into two categories: group and individual coverage. Employers, unions, and government agencies purchase group plans for workers. Group coverage usually costs less per person. Meanwhile, individual coverage involves a direct plan between the insurer and the policyholder.
One of the main reasons everyone needs health insurance is to cover unexpected medical expenses in case they get into an accident that requires emergency services and hospitalization. Instead of paying thousands of dollars out of your own pocket for an ambulance and treatment, your health insurance will cover it. Also, women going through pregnancy and maternity need health insurance to avoid the high costs involved. Enrolling in a healthcare plan gives you access to prescription drugs, lab tests, and other medical services.
Who Should Buy This Coverage?
Everyone can benefit from healthcare, which is why everyone needs health insurance unless you can afford to pay all your medical bills upfront. Individuals who are struggling financially can find affordable healthcare plans that fit their needs. Couples choosing to start a family should definitely enroll in a family plan if their employers do not already cover them.
Which Type of Health Insurance Should You Buy?
Many consumers find private health insurance shopping to be complex and confusing because of the diverse variety in coverage plans. Each individual must decide for themselves what plan works best for their personal needs since no one plan fits everyone. Some people prefer health management organizations (HMOs), which allow you to select healthcare providers from a network. PPOs, by contrast, allows you to choose out-of-network providers at lower costs.
Your age will also be a factor in the type of health insurance you purchase. Most seniors get coverage from the federally-funded insurance programs Medicare and Medicaid. College students have various healthcare options, such as coverage through their parents’ policy and discounted coverage through campus programs.
Other factors that affect healthcare costs include individual vs. family plans, location, and lifestyle (for instance, smoking habit). Another dimension to how healthcare plans are categorized involves how insurers and policyholders split costs. Here’s the metal tier system used to differentiate plans by percentages of cost-sharing:
- Bronze: patient pays 40%, insurer pays 60%
- Silver: patient pays 30%, insurer pays 70%
- Gold: patient pays 20%, insurer pays 80%
- Platinum: patient pays 10%, insurer pays 90%
How Does Health Insurance Work?
Health insurance is designed to protect you from expensive medical bills. As a policyholder, you pay an affordable monthly fee called a premium. It allows you and your family to have access to health care, which includes some free medical services stated in your policy. When you visit a doctor, you pay a deductible, which is a portion of the fee up to an amount you predetermine. If your plan has a deductible of $100, you pay the first $100, and then the rest is covered by the plan.
Since health plans can be very complicated, it’s helpful to work with private assistants to decode the medical jargon. It can help cut down on medical bills as you might be able to get lower prices for minimal coverage, depending on your needs. People with pre-existing conditions have higher risks, and so they might set higher coverage limits and deductibles than others.
How Much Does It Cost?
According to Kaiser Family Foundation, the average cost of health insurance for Americans in 2021 is about $452 per month. With a subsidy, the cost may be as low as $199 per month. Each state has its own profile when it comes to health insurance costs. Finding the cheapest health insurance may begin with the national Healthcare Marketplace, which bundles health and dental plans, but in a limited way.
What Are the Types of Health Insurance?
- Preferred Provider Organization – PPO plans cover patients at a specific hospital with a physician network. PPOs usually split costs with patients after the deductible kicks in.
- Exclusive Provider Organization – EPO plans are similar to PPOs, except they don’t cover charges outside the network other than for certain emergencies.
- Health Maintenance Organizations – HMOs are designed for strict networks that reward participants who remain in the network with complete coverage. They commonly offer lower premiums than other plans.
- Point of Service – POS plans mix PPOs and HMOs to provide less coverage associated with out-of-network services.
- High Deductible Health Plans – HDHPs provide policyholders with tax savings and Flexible Spending Accounts (FSAs). Some plans may involve an HMO or PPO.
Learning about health insurance and the many different plans available can be a time-consuming endeavor. You can speed up your learning curve by talking with an insurance professional who can directly answer your questions. Contact our team at C.V. Mason Insurance Agency to learn more about finding the right plan for your needs. We are a family business that’s been around for over a century offering a wide range of insurance plans.