Why should I have health coverage? No one plans to get sick or hurt, but most people need medical care at some point. Health insurance covers these costs and protects you from very high expenses. People without health coverage are exposed to these costs. This can some?mes lead people without coverage into deep debt or even into bankruptcy. Health coverage when you need care Health insurance is a contract between you and your 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 Marketplace (and most other plans) provide free preven?ve care, like vaccines, screenings, and check- ups. They also cover some costs for prescrip?on drugs. Health insurance protects you from high, unexpected costs 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 $7500? Having health coverage can help protect you from high, unexpected costs like these.
How does health insurance coverage work? When you have insurance, you pay some costs and your insurance plan pays some. Here are some common insurance terminologies: Premium: A premium is a fixed amount you pay to your insurance plan, usually every month. You pay this even if you don't use medical care that month. Deduc@ble: If you need medical care, a deduc?ble is the amount you pay for care before the insurance company starts to pay its share. Once you meet your deduc?ble, your insurance company begins to cover some costs of your care. Some plans have lower deduc?bles, like $250. Some have higher deduc?bles, like $2000. Many plans provide preven?ve services, and some?mes other care, before you've met your deduc?ble. Copayment: A copayment is a fixed amount you'll pay for a medical service aver you've met your deduc?ble. For example, aver mee?ng your deduc?ble you may pay $25 for a visit to the doctor's office that would cost $150 if you didn't have coverage. The health plan pays the rest. Coinsurance: Coinsurance is similar to copayment, except it's a percentage of costs you pay. For instance, you may pay 20% of the cost of a $100 medical bill. So you would pay $20 and the health plan would pay the rest.
How does health insurance protect you? Insurance coverage protects you from high medical costs 2 ways: Out- of- pocket maximum: This is the total amount you'll have to pay if you get sick. For example, if your plan has a $3000 out- of- pocket maximum, once you pay $3000 in deduc?bles, coinsurance, and copayments the plan will pay for any covered care above that amount for the rest of the year. No yearly or life@me limits: Health plans in the Marketplace can't put dollar limits on how much they will spend each year or over your life?me to cover essen?al health benefits. AVer you've reached your out- of- pocket maximum, your insurance company must pay for all of your covered medical care with no limit.
Key Features of the Affordable Care Act
Affordable Care Act - Basics On March 23, 2010, President Obama signed the Affordable Care Act. The law puts in place comprehensive health insurance reforms that will roll out over four years and beyond. Coverage Ends Pre- Exis@ng Condi@on Exclusions for Children: Health plans can no longer limit or deny benefits to children under 19 due to a pre- exis?ng condi?on. Keeps Young Adults Covered: If you are under 26, you may be eligible to be covered under your parent s health plan. Ends Arbitrary Withdrawals of Insurance Coverage: Insurers can no longer cancel your coverage just because you made an honest mistake. Guarantees Your Right to Appeal: You now have the right to ask that your plan reconsider its denial of payment. Costs Ends Life@me Limits on Coverage: Life?me limits on most benefits are banned for all new health insurance plans. Reviews Premium Increases: Insurance companies must now publicly jus?fy any unreasonable rate hikes. Helps You Get the Most from Your Premium Dollars: Your premium dollars must be spent primarily on health care not administra?ve costs.
Affordable Care Act - Basics Care Covers Preven@ve Care at No Cost to You: You may be eligible for recommended preven?ve health services. No copayment. Protects Your Choice of Doctors: Choose the primary care doctor you want from your plan s network. Removes Insurance Company Barriers to Emergency Services: You can seek emergency care at a hospital outside of your health plan s network.
What is the Health Insurance Marketplace? The Marketplace is a new way to find health coverage that fits your budget and meets your needs. With one applica?on, you can see all your op?ons and enroll. When you use the Health Insurance Marketplace, you'll fill out an applica?on and find out if you: Qualify for lower out- of- pocket costs. Qualify for free or low- cost coverage available through Medicaid or the Children's Health Insurance Program (CHIP). Can get lower costs on your monthly premiums for private insurance plans Open enrollment starts October 1, 2013. Plans and prices will be available then. Coverage starts as soon as January 1, 2014. The Health Insurance Marketplace is some?mes known as the health insurance "exchange."