How does Health Insurance in the USA Work?

A guide to healthcare in America.

Health care is one of the most important things, and unfortunately it is very expensive in United States. A single consultation can cost several hundreds of dollars and an average stay in hospitals is enough to completely finish any savings one might have. Health insurance offers a way to reduce such costs to more reasonable and affordable amounts.

Typically a health insurance plan works by making the consumer pay an upfront premium to the insurance companies which allows that payment to be shared with lots of other people. Here are answers to three of the most commonly asked questions while inquiring about health care insurance.

Where can one receive care?
The primary way for insurance plans to control their cost is to influence providers. Providers can be physicians, hospital, labs, and other medical care providers. The insurance companies have contracts with such providers in exchange of more favorable pricing. If a provider you are going to care for is not in your insurer’s network, the company may not pay for the services or may pay for a smaller portion. Make sure to check whether the hospital or any other institute you are going to is covered under your insurer’s network.

What does the plan cover?
The Affordable Care Act brought immense reforms and introduced more standardization in insurance plan benefits. Plans in the U.S. are required to offer the following benefits:

  • Emergency services
  • Hospitalization
  • Laboratory tests
  • Maternity and newborn care
  • Mental health and substance-abuse treatment
  • Outpatient care
  • Pediatric services
  • Prescription drugs
  • Preventive services
  • Rehabilitation services 

Anything which is in the list above will have to be included in any health insurance plan. If you need anything which is not a part of the above list, you will have to consult your insurance company to make sure that they will pay for it.

How much will the insurance cost?
The premium one pays while enrolling in a plan is an upfront cost which is transparent to you. However, this isn’t the only cost associated with the insurance. Typically, there is an additional expense whenever you receive medical care. Generally, the more you pay for the premium, the less these costs are but one should always check with the insurance provider and their plan to correctly identify how much it will cost you if you need to get medical treatment.

Health insurance is a very essential need one should always have, and you should always research carefully about your insurance company and their plan to make sure that you understand all the caveats and associated costs that come with it. The time spent for a little research can make a big difference in your future.

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