Health insurance is a contract between you and your insurance company. You buy a plan and the company agrees to pay part of your medical costs when you get sick or hurt.
5 Things to Know About Health Insurance
- There are many kinds of private health insurance policies. Different kinds of policies can offer very different kinds of benefits, and some can limit which doctors, hospitals or other providers you can use.
- You may have to pay coinsurance or a copayment as your share of the cost when you get a medical service like a doctor's visit, hospital outpatient visit or a prescription. Coinsurance is usually a percentage amount (for example, 20 percent of the total cost). A copayment is usually a fixed amount (for example, you might pay $10 or $20 for a prescription or doctor appointment).
- You may have to pay a deductible each plan year before your insurance company starts to pay for your care. For example, if you go to the emergency room and the total cost is $1,250, you will pay the first $200 if your deductible is $200. Once you pay the $200, your insurance will begin to pay its share.
- Health insurance plans contract with networks of hospitals, doctors, pharmacies and health care providers to take care of people in the plan. Depending on the type of policy you buy, your plan may only pay for your care when you get it from a provider in the plan's network. If you see a provider outside of the plan's network, you may have to pay a bigger share of the bill.
- You may see products that look and sound like health insurance but don't give you the same protection as full health insurance. Some examples include policies that only cover certain diseases, policies that only cover you if you're hurt in an accident, or plans that offer you discounts on health services. Don't mistake products that look like insurance for full comprehensive insurance protection.
Benefits of health insurance
No one plans to get sick or hurt, but most people need medical care at some point. Did you know the average cost of a three-day hospital stay is $30,000 or that fixing a broken leg can cost up to $7,500? Health coverage helps pay for these costs and protects you from high, unexpected costs like these.
Many plans also provide free preventive care like vaccines and checkups and cover some costs for prescription drugs. Your insurance policy or summary of benefits and coverage will show what types of care, treatments and services are covered, including how much the insurance company will pay for different treatments in different situations.
What you pay for health insurance
You'll usually pay a premium every month for health coverage. You may also have to meet a deductible once each year before the insurance company starts to pay its share. How much you pay for your premium and deductible is based on the type of coverage you have.
Learn more
For more information about how insurance works, please visit HealthCare.gov . You can also call the Marketplace Call Center at 1-800-318-2596. Teletypewriter (TTY) users should call 1-855-889-4325.
Mission Family Medicine is providing this information to help our patients understand their health insurance options. We are not providing this information on behalf of a state or federal exchange or health insurer. This information is not a recommendation or endorsement of the exchange or any insurance product offered on the exchange.