Health coverage helps pay costs when you need care. No one plans to get sick or hurt, but most people need medical care at some point. Health coverage helps pay for these costs and protects you from very high expenses.
What is health insurance?
Health insurance is a contract between you and an insurance company. You buy a plan, and the company agrees to pay part of your medical costs when you get sick or hurt.
There are other important benefits of health insurance. Plans available in the Health Insurance Marketplace (and most other plans) provide free preventive care, like vaccines and check-ups. They also cover some costs for prescription drugs.
Health insurance helps you pay for care. Did you know the average cost of a 3-day hospital stay is $30,000? Or that fixing a broken leg can cost up to $7,500? Having health coverage can help protect you from high, unexpected costs like these. Your insurance policy, or summary of benefits and coverage, will show what types of care, treatments, and services your plan covers, including how much the insurance company will pay for different treatments in different situations.
What do you pay for health insurance?
You’ll usually pay a premium every month for health coverage, and you may also have to meet a deductible once each year before the insurance company starts to pay its share. A deductible is the amount you owe for health care services that your health insurance or plan covers before your health insurance or plan begins to pay. For example, if your deductible is $1,000, your plan won’t pay anything until you’ve met your $1,000 deductible for covered health care services subject to the deductible. The deductible may not apply to all services. How much you pay for your premium and deductible is based on the type of coverage you have. Just as important as the premium cost is how much you have to pay when you get services. The policy with the cheapest premium may not cover many services and treatments.
Fee Examples include:
• How much you pay for care before your insurance company starts to pay its share (a deductible)
• What you pay out-of-pocket for services after you pay the deductible (coinsurance or copayments)
• How much in total you’ll have to pay if you get sick (the out-of-pocket maximum)
What is the Health Insurance Marketplace?
The Health Insurance Marketplace is a way to find health coverage that fits your budget and meets your needs. With one application, you can see all your options and enroll. You can apply for private insurance, Medicaid, or the Children’s Health Insurance Program (CHIP). Every health plan in the Marketplace offers the same set of essential health benefits, including doctor visits, preventive care, hospitalization, prescriptions, and more. You can compare plans based on price, benefits, quality, and other features important to you before you make a choice. Insurance plans offered through the Marketplace are run by private companies. No matter where you live, you’ll be able to compare your health coverage options in the Marketplace and see what your premium, deductibles, and out-of-pocket costs will be before you make a decision to enroll. There are protections for you and your family. Insurance plans can’t deny you coverage because of pre-existing or chronic conditions like cancer or diabetes, and they can’t charge women and men different premiums. When you use the Marketplace you may be able to get lower costs on your monthly premiums and out-of pocket costs. When you apply, you’ll find out how much you can save. Most people who apply will qualify for some kind of savings. Explore the Marketplace now
When Open Enrollment starts, you can go to the Marketplace and apply for health coverage, compare all your options, and enroll in a plan. If you qualify for a Special Enrollment Period (SEP), you may apply for coverage outside of the Open Enrollment Period. You also can apply for Medicaid and the Children’s Health Insurance Program (CHIP) any time of the year, using the same application.
Visit the Health Insurance Marketplace at healthcare.gov
5 things you can do to get ready to enroll
- Explore the Marketplace. Visit HealthCare.gov to learn more about the Health Insurance Marketplace and programs you may qualify for, including Medicaid and CHIP.
- Ask your employer if it plans to offer health insurance. Some employers will take advantage of the Small Business Health Options Program (SHOP) to provide health coverage to employees. If not, you may need to get coverage through the Marketplace or other sources.
- Make a list of questions you have before it’s time to choose your health plan. For example, “Can I stay with my current doctor?” or “Will this plan cover my health costs when I’m traveling?” This will help you as you compare different health plans.
- Gather basic information about your household income. Most people using the Marketplace will qualify to save money. To find how much money you’re eligible for, you’ll need income information, which can be found on you W-2, pay stubs, or tax return.
- Set your budget. There are different types of health plans to meet a variety of needs and budgets. You’ll need to figure out how much you’re able to spend on premiums each month. Think about your health care needs when choosing a plan. If you expect a lot of doctor visits or need regular prescriptions, you might want to select a plan that has higher monthly premiums, but pays more of the costs when you need care. You could pay lower out-of-pocket costs for each visit, prescription, or other medical service.
Certified Application Counselor Amy Alexander is available for assistance with the Marketplace enrollment by calling (814) 643-8885.