A set of 10 categories of services that health insurance plans must cover under the Affordable Care Act. These include medical services, inpatient and outpatient hospital care, prescription drug coverage, pregnancy and childbirth, mental health services, and more. With all health plans, consumers pay a monthly insurance premium regardless of whether or not they use health care services. Premiums are usually higher for plans that pay more of your medical expenses when you get care, such as Gold and Platinum plans.
In general, premiums are also higher for plans that have lower deductibles and coinsurance amounts. In addition to the four levels of metal coverage, a catastrophic level is available for people under 30 and for certain people over 30 who are granted exemptions for financial hardship based on their income and other circumstances that prevent them from obtaining a Bronze, Silver, Gold or Platinum plan. There are 14 reasons why a person can be granted an exemption for financial hardship, such as being homeless; having suffered substantial property damage as a result of a fire, flood, or other disaster; and filing for bankruptcy within the last three years. The more insurance pays for medical expenses, the higher the monthly premium.
Some people opt for a category like Bronze or Catastrophic if they don't anticipate a lot of medical expenses. For those who visit the doctor frequently, anticipate a major medical event, or require several medications, a category such as Silver, Gold or Platinum may be the most appropriate. In the National Health Interview Survey, researchers found that 63.7% of people under 65 in the United States are usually based on discounts that health insurers negotiate with doctors or hospitals. A popular aspect of the Affordable Care Act is its requirement that all individual and small group health plans (for people who don't have traditional work coverage) cover important health benefits, such as maternity, mental health, preventive and pediatric dental care.
Health plan categories refer to the four types of health insurance plans, which are differentiated according to the average percentage of health care expenses that the plan will pay. All plans cover the same essential health benefits; the difference is in what you pay in the monthly premium and the out-of-pocket costs when you need care. HealthMarkets Insurance Agency is an authorized and certified representative of Medicare Advantage's HMO, PPO and PPFS organizations and independent prescription drug plans. A deductible is the amount you pay each year before your health plan starts paying for covered services.
Health Maintenance Organization (HMO) plans generally only fund treatment referred by a family doctor and have negotiated rates for each medical service to minimize costs. The level of treatment a person receives in emergency departments varies significantly depending on the type of health insurance they have. Employer-provided group health insurance plans offer lower-cost insurance for employees, since the employer pays a portion of the premium. You choose a health insurance plan based on the cost of the plan and the services and benefits it covers.
Health insurance also helps you protect your health and well-being, mainly through coverage for preventive care services. The best way to buy health insurance is to better understand the individual and family plans that are available. The Affordable Care Act requirement that essential health benefits be covered without annual dollar limits provides patients with more health benefits and a lower financial burden. However, the rate of people with health insurance is still higher than before the introduction of the Affordable Care Act.
Health insurance limits the risk of having to pay for very expensive illnesses and injuries by covering medical care and other services, such as hospitalization and surgery. .