Who needs health insurance? The answer is easy, everyone! No matter your age, gender or shoe size, you need health insurance. Just like you need car insurance, in case anything happens to your vehicle, health insurance will cover you if you become sick or suffer an injury. Not only will it protect you in an accident or emergency, health insurance also covers things like preventative care, vaccines and screenings-which could essentially prevent you from becoming sick later on down the road.
While everyone needs health insurance, if knowing the ins, outs, whys and how to of “health insurance” seem like a foreign language to you, you’re not alone!
We all probably know that health insurance, in its simplest terms, is essentially a product provided to help assist in covering medical expenses, but it is anything but simple after that. According to Pew Research Center, at least 37% of us go online to try to figure it all out. We’ve taken some of the most commonly used terms and are pulling back the curtain on what they really mean:
A deductible is the amount of money that you are required to pay for covered services before you can use the benefits from your health insurance plan. Nevada Health Link’s health marketplace gives the example; if your deductible is $2,000, you will have to pay $2,000 in medical expenses on your own or “out of pocket.” Once you have reached your deductible you will either pay nothing for future medical expenses, or you will have to pay a co-payment for covered services, and your insurance will then cover the remaining costs. It is important to note that deductibles vary from plan to plan. Your deductible amount and what is exempt from the deductible will be outlined in your insurance plan language so you will know what your annual deductible is before you choose a plan.
Often referred to simply as “copay,” this term describes a fixed amount of money, set by your insurance provider, that you pay for covered services. For example, if you break your arm and go to a clinic to have it set, you may be told your copay for service is $50. If you have met your deductible and your copay is $50, you will pay $50 and your insurance should cover the rest of the bill. As with deductibles, something to keep in mind is that copayments can vary in cost based on different services such as doctor visits, emergency room visits, filling prescriptions or lab tests.
Each month you will pay a set amount of money for your health insurance coverage. This is known as a premium. Keep in mind that a low monthly premium may cost you more out-of-pocket expenses. How much you pay for your monthly premium does not equate to how much you will pay for healthcare services. Nevada health marketplace so states that an insurance plan with a slightly higher premium but a lower deductible could save you a lot of money in the long run.
Tim.com Money tapped Katy Votava, founder of health insurance consulting firm Goodcare, who suggests this simple equation to see how much you might really pay. Take the monthly premium amount from the plans you are evaluating, multiply by 12, and then add to this number the deductible plus any out-of-pocket maximum you would be responsible to pay. This is the total amount you would be required to pay if you had a health crisis this year.
Just like your circle of friends and colleagues, in-network providers, suppliers and facilities have been contracted by the insurer to provide approved health care services. Insured individuals will likely pay less when using an in-network provider vs. an out-of-network provider. Going “out-of-network,” or getting services through a provider or facility that hasn’t been approved may result in the insurer paying a smaller percentage of what would have been paid if you had stayed in-network – or no payment at all – leaving you responsible to pay the entire fee on your own.
How to find affordable health insurance?
This is where we come in. Nevada Health Link is designed to help you find an insurance plan that fits your needs and your budget, and answer all of your insurance questions. Just like shopping at the mall, Nevada Health Link allows you to compare and purchase health insurance plans through our online marketplace. We are also the only health insurance resource that can provide you with federal tax credits and subsidies to help pay for all or part of your insurance.
When should you buy health insurance?
There is only one time per year that you can sign up for health insurance coverage, which is known as open enrollment. This year, open enrollment is much shorter than previous years. It will begin on November 1st and end on December 15th. If you do not enroll before midnight on December 15th, you will not be able to purchase qualified health plans until the following year during open enrollment, or unless you qualify for a “special enrollment period.” As part of a Qualifying Life Event (QLE) you could be eligible for a special enrollment period. These QLE’s are determined on a case-by-case basis, for example, things such as marriage, birth, adoption or moving to a new location, are often life changes that could make you eligible for special enrollment.