Health insurance is a type of protection that helps pay for medical expenses. People can get health insurance through their employers, the marketplace or directly from an insurer. Typically, people with health insurance pay a monthly premium that goes toward the cost of care. Health insurance also often includes deductibles and co-pays. The goal is to help pay for unexpected, costly medical bills due to illness or injury.
A key aspect of health insurance is its network of providers. These are doctors, hospitals and other facilities that have a contract with the insurance company to provide services at a discounted rate. People with health insurance are usually required to see providers in their network, but can go out-of-network for emergencies or if the plan gives them pre-approval. The network may also include pharmacies that have a contract with the insurance company for prescription drug coverage.
Another feature of health insurance is its set of rules and guidelines that describe what types of care are covered. The rules and guidelines are generally based on accepted standards of medicine. For example, the rules and guidelines may state that certain procedures are only covered after a hospital stay or that patients must get prior authorization for certain drugs. Some insurance programs, such as Medicare and Medicaid, have strict coverage requirements while others allow greater flexibility.
Having health insurance can help make it easier to navigate the complex healthcare system. However, the KFF found that consumers still face a lot of barriers when it comes to getting health care. For example, a significant number of individuals struggle with signing up for coverage and dealing with problems such as denied claims and difficulty getting information from their health insurance companies. In some cases, these obstacles can be overcome by working with a well-staffed human resources department or other advocates. But many people do not have this kind of support and are left on their own to find solutions to their problems.
In addition to the complexity of finding and using health care, some people have trouble affording it. For example, if a person loses their job and therefore their group health insurance, it can be difficult to find replacement coverage. People may have to wait for public programs to reopen or they can try to buy an individual plan or family plan on their own.
Individual plans typically cover a single person and family plans cover multiple people under one policy. It is important to assess a person’s needs and those of his or her family before choosing the right health plan. Some plans have a feature known as lifetime renewability that ensures financial protection for a long period of time. This is an excellent option for those who do not want to keep buying new plans every few years. It is also a good idea to consider a plan that covers preventive visits and certain vaccinations, since these are typically not expensive. However, a person should always check the fine print of the policy to confirm that these benefits are included.