What is health insurance?
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Health insurance is a type of coverage that pays for medical and surgical expenses incurred by the insured. It may also provide coverage for other types of health-related costs, such as prescription drugs, mental health services, and preventive care.
Why do I need health insurance?
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Health insurance helps protect you from high medical costs. It provides access to medical care when you need it, helping to pay for doctor visits, hospital stays, surgeries, prescription medications, and other health-related services.
What is a premium?
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A premium is the amount you pay for your health insurance every month. Depending on your plan, the premium may vary based on factors like age, location, and level of coverage.
What is a deductible?
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A deductible is the amount of money you must pay out-of-pocket before your health insurance starts covering your medical expenses. For example, if you have a deductible of $1,000, you must pay $1,000 out-of-pocket before your insurance starts covering your medical bills.
What are copayments and coinsurance?
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Copayment (copay): A fixed amount you pay for a covered health care service, typically when you get the service. Coinsurance: The percentage of the cost you pay for covered health services after you've paid your deductible. For example, if your coinsurance is 20%, you pay 20% of the bill, and the insurance company pays the remaining 80%.
What is an out-of-pocket maximum?
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The out-of-pocket maximum is the maximum amount you can spend on your health insurance. If you exceed this amount, your insurance company will pay 100% of your medical expenses.
What is the difference between in-network and out-of-network providers?
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In-network providers: Health care providers that have a contract with your health insurance plan to provide services at negotiated rates. Out-of-network providers: Providers that don't have a contract with your insurance plan. Services from these providers may cost more or not be covered at all.
What is a Special Enrollment Period (SEP)?
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The Special Enrollment Period (SEP) is a special time during the year when you can sign up for or make changes to your health insurance plan. If you miss this period, you may have to wait until the next one unless you qualify for a Special Enrollment Period (e.g., due to a life event like marriage or having a baby).
Can I keep my doctor with health insurance?
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If you have a preferred doctor, it’s important to check if they are in-network with your insurance plan. If they are not in-network, you may need to pay more out-of-pocket, or you may have to switch to another doctor who is in-network.
What is a Health Savings Account (HSA)?
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A tax-advantaged account for people with high-deductible health plans (HDHPs). The funds roll over from year to year and can be used for qualifying medical expenses.
What is a Flexible Spending Account (FSA)?
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A tax-advantaged account for people with low-deductible health plans (LDHPs). The funds roll over from year to year and can be used for qualifying medical expenses.
What is a Health Maintenance Organization (HMO)?
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An HMO is a type of health insurance plan that requires you to choose a primary care physician (PCP) and get referrals from them to see specialists. HMOs often have lower premiums and out-of-pocket costs but offer less flexibility in choosing providers.
What is a Preferred Provider Organization (PPO)?
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A PPO is a health insurance plan that offers more flexibility in choosing healthcare providers and doesn’t require referrals to see specialists. You can see any doctor, but you’ll pay less if you use in-network providers.
What is the difference between a Health Savings Account (HSA) and a Flexible Spending Account (FSA)?
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HSA: A tax-advantaged account for people with high-deductible health plans (HDHPs) The funds roll over from year to year and can be used for qualifying medical expenses. FSA: A tax-advantaged account for people with low-deductible health plans (LDHPs) The funds roll over from year to year and can be used for qualifying medical expenses.
What does the term "pre-existing condition" mean?
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A pre-existing condition is a medical condition that you had before you got your health insurance. It could include things like diabetes, high blood pressure, or heart disease.
Can I cancel my health insurance at any time?
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Yes, you can cancel your health insurance plan at any time. However, if you cancel outside the open enrollment period, you may not be able to get another plan until the next enrollment period unless you qualify for a Special Enrollment Period.
Are prescription drugs covered by health insurance?
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Many health insurance plans cover prescription medications, but the coverage may vary. Plans typically have a formulary, or list of covered drugs, and different drugs may have different levels of coverage, depending on whether they are generic, brand-name, or specialty drugs.
What is preventive care?
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Preventive care includes health services that help prevent illnesses, such as vaccinations, screenings, and annual checkups. Under the Affordable Care Act, most preventive services are covered by health insurance plans at no additional cost to the policyholder.
What should I do if my health insurance claim is denied?
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If your claim is denied, you can appeal the decision. Review the denial letter for reasons, contact your insurer for assistance, and file a written request for a hearing. If you win the appeal, you may be able to get a refund or other compensation.
How can I choose the best health insurance plan for me?
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When selecting a plan, consider factors like: Your health care needs (e.g., frequent visits, prescriptions) The plan’s network of doctors and hospitals The cost of premiums, deductibles, copays, and out-of-pocket maximums Coverage for specialized care or treatments Compare the different plans and benefits to find one that meets your needs.
What happens if I don't have health insurance?
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If you don’t have health insurance, you can still access some health care services, such as emergency care, in-network doctors, and in-network hospitals. You may be eligible for Medicaid, which provides some health care services at no cost to you.
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