When it comes to healthcare in the United States, the cost can be prohibitive. Moreover, because there is no universal healthcare in place for all citizens, it is necessary for most people to have a healthcare plan in place to cover them in case of illness or injury.

How Does Healthcare Insurance Work?

Healthcare plans are provided by various insurance companies as well as government programs such as Medicaid and Medicare. Private healthcare insurance plans are paid for on a monthly basis by the consumer. With millions of people paying for healthcare insurance and only a small number of people claiming at any one time, insurance companies are able to cover the cost of treatments when these arise.

What to Know About Private Plans

Healthcare plans are often limited in where you can get treated and in terms of what is covered. For example, most insurance companies will use a network of healthcare providers that have agreed to provide treatments for a specific price. This means that in order to be covered, you would have to use a network provider.

The experts at Find-A-Code.com say that if you were to choose to have treatment from a provider outside of the network, you may not be covered or the insurance company might decide to pay a lower amount. This is something that is checked during the medical billing process.

Something else you need to know is that not every treatment is covered by insurance. There is specific ‘health benefits’ that plans must cover these days, including:

  • maternity services
  • newborn care
  • emergency services
  • outpatient care
  • mental health treatment
  • laboratory tests
  • substance abuse treatment
  • pediatric services to include vision and dental
  • rehabilitation services
  • prescription medication
  • preventative treatments such as vaccinations, blood tests, and screenings.

Furthermore, just because you may have healthcare insurance that you are paying for on a monthly basis does not mean that you will not have anything else to pay should you access healthcare. There are different plans available and how much you will have to pay when you access treatment will depend on the type of plan you have.

You might have to pay out-of-pocket expenses, which is the amount you have to contribute towards the treatment. Your plan may also include a yearly deductible, which is the amount you need to pay over the course of the year before you can start claiming from the insurance provider.

Coinsurance is a percentage of the cost of medical treatment that you need to pay. You might have a 20-80 split with your insurance provider, whereby you pay 20 percent of the cost and the insurance company pays the other 80 percent.

Copayment is the name given to any upfront payment that you are required to pay when you get treatment. The amount of the copayment will depend on the treatment accessed and will be specified in the plan. Once you have paid the copayment, the insurance company will pay the rest.

What Treatments are Not Covered?

There are some treatments that are typically not covered by any healthcare plan. For example, most elective procedures such as cosmetic surgery would be classed as medically unnecessary and therefore not covered. While pre-existing conditions were once excluded from healthcare plans, they must be covered now. However, there is usually a wait period of a year or more before a claim can be made.

To conclude, healthcare insurance is a monthly premium that consumers pay to reduce the amount that they pay towards medical treatment. The type of plan you choose will determine how much extra you will pay when you access care.