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How to Navigate Health Insurance

Medical visits and procedures, like x-rays, can be expensive. That is why most people in the U.S. have some form of health insurance. But how does health insurance work?

This article aims to help you understand this topic better.

What is Health Insurance?

Basically, health insurance helps cover part (or all) of the cost of medical visits and procedures. A health insurance plan usually doesn’t cover dental and vision costs. These usually have a similar, but separate sign-up process.

Where Can You Get Health Insurance?

Some individuals get their health insurance through their employer. While others get their insurance through the federal government’s online site for health insurance called the Marketplace. If you make under a certain amount of money, you may be eligible for Medicaid.

What’s a Health Insurance Plan?

Each health insurance plan is different in terms of what costs it covers and how much it covers. If you are in the process of choosing a health insurance plan, it’s important to read about the different plans to get an idea of what expenses each one covers.

What’s a Premium?

Each health insurance plan costs a certain amount of money just to join and stay enrolled. The amount you pay each month just to have the health insurance plan is called the “premium.”

Typically, the higher the premium, the less you will have to pay for visits and procedures.

Check out the healthcare.gov glossary to learn more about health insurance terms.

What Types of Health Insurance Plans Exist?

Preferred Provider Organizations (PPO) – has a list of providers who are within the network of the insurance company. These providers are known as “in network”. It costs less to see these providers than “out of network” providers.

Exclusive Provider Organizations (EPO) – covers the cost of the providers who are in-network. If a policyholder seeks out a provider who is out-of-network, the insurance plan will not cover any of the costs.

Health Maintenance Organizations (HMO) – requires that you have a primary care provider, who will take care of your basic health needs and will refer you to specialized care if needed. Typically, the only out of network services covered by an HMO plan is emergency or urgent care services.

If you cannot afford these plans, you may be eligible for Medicaid – a public insurance program that provides free or low-cost health coverage to some low-income people, families and children. You can apply to Medicaid anytime. If you make a little too much money for Medicaid, you might be eligible for CHIP – a public insurance program that provides low-cost health coverage to children in families that earn too much money to qualify for Medicaid but not enough to buy private insurance. You can apply any time.

Resources

Author: Originally from Oklahoma, Summer Lewis is a Muscogee and Seminole woman working in Tribal public health in Northern California. She is preparing to start her first semester of her Master’s program at the University of California-Berkeley’s School of Public Health and enjoys baking, beading, and being outdoors.

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