For all Americans, health insurance is an absolute must. Even for those in great health, accidents or emergencies can happen at any time and, without adequate coverage, lead to huge costs. To make matters worse the healthcare system in the United States can appear dauntingly complex to those unfamiliar with how to navigate it. Fortunately, despite that apparent complexity, it is not as hard to find the right coverage for you and your family as you might think, though it can be a time consuming process.

Understanding the Essentials

Chances are that if you have ever taken a look at a health insurance invoice from a provider, or tried to make sense of a medical bill, you have been confronted by variety of confusing terminology that has left you unsure of what exactly you are paying for. That is understandably a concern considering the importance of health insurance. So to help you better make sense of your health insurance policy, below are some of the essential terms you are likely to encounter:

Provider: any entity that provides healthcare services. This most often refers to hospitals and doctors who provide care for patients. Doctors are either generalists, who will see to your general needs like annual physical exams, and specialists, who as the name suggests are experts in a specific field of medicine. When you see a provider for a medical appointment, they will work with your health insurance company to determine how much of the cost your health insurance will cover and what you will need to cover personally.

Premium: what you pay to your health insurance provider on a regular basis. As with other sorts of insurance such as automobile or home insurance, you will need to pay this every month, whether you use your health insurance or not.

Co-pay: what you pay when you visit a provider for medical care. It is usually paid every time you have an appointment, even if you are returning for a follow-up visit.

Deductible: what you pay out of your own pocket when you need medical care before your health insurance company begins to cover costs. This restarts every year. For example, if your deductible is $2,000, you will need to pay any medical expenses up to $2,000 yourself, whilst your insurance will cover any excess costs. The higher your premium, the lower your deductible will be and vice versa. Those who don’t visit the doctor often are usually well-advised to choose a lower premium plan, as the chance that they will incur high medical charges is less likely.

Enrolling in a Health Insurance Plan

Enrolling will look different for everyone. But the most important factor in determining how you apply for health insurance will be whether your employer offers healthcare plans. Those with an employer that does offer plans will most likely have a menu of choices. It’s a good idea to understand each plan and what is best for you by sitting down and talking with whoever at your company or organization is in charge of managing the plans. Your premium would most likely be deducted from each pay check, but your employer may well help to cover some of the cost.

For those who are self-employed, newly unemployed or work for an organisation that doesn’t offer health insurance, there are still a variety of options. Many people in recent years have used the federal health insurance marketplace, better known as ‘Obamacare’, to find the right coverage for them. The marketplace offers plans to those who for one reason or another are not covered by an employer and offers federal subsidies to help with the costs of premiums. There are a range of plans offered. ‘Obamacare’ plans may be particularly suitable for younger people, who work more flexibly and don’t typically require regular medical appointments.

It is essential to think about what you need in a health insurance plan and make your decisions based on the conclusions you have reached. If you don’t have many medical needs, a lower-tier plan with a lower premium and higher deductible is probably right for you. Alternatively, if for example you need to make frequent visits to see a specialist such as a dentist or an optometrist, find a plan that includes dental or vision insurance, or consider enrolling in a supplemental dental or vision plan on top of your primary healthcare plan.

The health insurance world may seem complex, but it is possible to navigate. The key is careful consideration and thorough preparation. Finding the right plan for your situation is essential, but it is not a decision you need to rush. So don’t.


About Joshua Frisch


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