Health insurance is a contract between an insurer and an individual or employer group that guarantees payment for some or all of the costs associated with a medical emergency or sickness. It is typically a monthly fee, or premium, paid by the insured in exchange for a promise by the insurer to pay for certain expenses related to health care. The underlying principles are universally recognized, but the details and costs vary widely from one policy to another, as do quality and customer service. Health insurance may be purchased through private sources such as individual policies sold on the market or through employer groups, or it may be provided by the government through programs like Medicare and Medicaid.
When choosing a plan, the most important factor is whether it will meet your health needs and budget. Eliminate plans that don’t have your preferred doctor or prescription drugs in their provider network, and make a list of the features you want in your policy. For example, if you’re healthy and don’t expect to visit the doctor often, a lower monthly premium with a higher deductible might be the right choice for you. If you anticipate frequent use of health services, on the other hand, it might be better to opt for a higher monthly premium with lower out-of-pocket costs like deductibles and coinsurance.
In addition, examine the types of benefits offered by different plans. Look for a balance of the 10 essential health benefits (EHBs) as required by the Affordable Care Act, as well as other coverage that might be important to you such as maternity coverage or mental health services. Some plans also offer other perks like wellness programs or discounts on vitamin supplements.
It’s also worth checking out a company’s reputation for customer service. JD Power and other ratings, as well as consumer complaints, can help you gauge the level of satisfaction with a company’s policies and customer support.
Finally, it’s important to read and understand all of the terms and conditions of a plan before purchasing. This information is usually available in the form of a member contract, Evidence of Coverage booklet or policy document for private plans, and a national health policy for government-sponsored coverage. By taking the time to review these documents, you can be a more educated health insurance consumer and avoid costly mistakes. If you have any questions, do not hesitate to reach out to the insurance company directly for clarification on anything that is not clear from these documents. They are there to help!