Health Insurance – What You Need To Know

Health insurance is a type of insurance coverage that provides financial protection for medical expenses. It is designed to help cover the cost of healthcare services including preventive care, doctor visits, hospital stays, surgeries and prescription drugs. Health insurance policies can be provided by an employer, purchased by an individual or obtained through government programs such as Medicare or Medicaid. Health insurance policies typically include deductibles, copays and coinsurance which are the amounts the insured must pay out of pocket for healthcare services. Health insurance helps ensure that individuals have access to necessary medical care without facing financial hardship.

Health Insurance Coverage

The specific services included in a health insurance coverage can vary widely depending on the insurance policy, the insurance company and the type of coverage. However, some common services that may be included in health insurance coverage are:

Doctor visits: Office visits to a primary care physician or specialist for diagnosis, treatment and management of medical conditions.

Hospital stays: Inpatient hospital care including surgery and other medical procedures.

Preventive care: Regular check ups, screenings and immunizations to maintain good health and prevent the onset of diseases.

Prescription drugs: Coverage for medications prescribed by a doctor including generic and brand name drugs.

Mental health services: Coverage for mental health and behavioral health services including therapy, counseling and psychiatric care.

Rehabilitation services: Physical therapy, occupational therapy and speech therapy to help recover from injury or illness.

Maternity and newborn care: Coverage for prenatal care, delivery and care of a new baby.

It’s important to keep in mind that insurance policies and coverage can vary so it’s a good idea to carefully review your policy and understand what is and is not covered before seeking medical care.

How To Choose Best Health Insurance

Choosing the best health insurance can be a complex and confusing process but it is important to have a clear understanding of your needs and options to make an informed decision. Here are some steps you can follow to choose the best health insurance:

Evaluate costs: Consider not only the monthly premium but also the out of pocket costs such as deductibles, copays and coinsurance to get a complete picture of the cost of the insurance policy.

Read the fine print: Carefully review the policy’s terms and conditions including exclusions and limitations to make sure you understand exactly what is and is not covered.

Research your options: Compare different insurance policies offered by different insurance companies taking into account factors such as coverage, deductibles, copays and coinsurance.

Seek professional advice: If you are having difficulty making a decision consider speaking to a healthcare professional or insurance broker who can help guide you through the process.

Check for additional benefits: Some insurance policies may offer additional benefits such as wellness programs, telemedicine services or discounts on gym memberships.

Determine your healthcare needs: Consider your current health, any pre existing conditions, the likelihood of needing certain medical procedures in the future and any prescription drugs you take regularly.

Consider the network of healthcare providers: Make sure that your preferred healthcare providers are included in the insurance company’s network.

By following these steps, you can make an informed decision and choose the best health insurance policy that meets your needs and budget.

How To Get Health Insurance

There are different ways to get health insurance coverage including:

Employer Sponsored Insurance

Employer sponsored insurance is also known as group health insurance which is a health insurance policy that is provided by an employer to its employees and their dependents. The employer pays a portion of the premium while the employee may be responsible for paying the rest through payroll deductions. This type of insurance is typically less expensive than individual health insurance policies and can offer a wider range of coverage options. Employer sponsored insurance plans are often customizable with the employer choosing the insurance company, the policy options and the level of coverage offered. This type of insurance is a good option for employees who have access to it as it can provide comprehensive coverage at a lower cost.

Personal Health Insurance

Personal health insurance is also known as individual health insurance which is a type of health insurance coverage that is purchased directly by an individual rather than through an employer or other group. This type of insurance provides coverage for medical expenses including hospital stays, doctor visits, prescription drugs and other types of medical care. Individual health insurance policies can be purchased through an insurance company or through a health insurance marketplaces.

Health Insurance Marketplace

A health insurance marketplace is a platform where individuals and families can compare and purchase health insurance plans. The marketplace provides a range of insurance options and information on costs, coverage and benefits to help consumers make informed decisions about their health insurance coverage. Health insurance marketplaces offer a range of insurance options including individual and family health insurance policies and can provide access to subsidies and tax credits to help lower the cost of coverage. Consumers can also compare plans based on factors such as premium costs, out of pocket expenses, network size and covered benefits.

Health Insurance Broker Or Agent

Health insurance brokers or agents are individuals or companies that provide assistance to consumers in selecting and purchasing health insurance policies. They can provide information on different types of health insurance coverage and help you compare policy options and answer questions about insurance benefits and costs. Health insurance brokers or agents are often knowledgeable about the health insurance industry and can help you navigate the complex world of insurance policies and options. They can help you understand the differences between various types of health insurance coverage and assist you in selecting a policy that meets your needs and budget.

Buy Directly From Health Insurer

Buying health insurance directly from a health insurer can be a good option for individuals who are comfortable researching and comparing health insurance policies on their own. It can also be a good option for those who want a specific insurance company’s policies and prefer to purchase directly from the source. When getting health insurance directly from a health insurer, it’s important to carefully review the policy options and compare costs and coverage options to find the best policy for your needs. You should also consider the financial stability of the insurance company and its reputation for customer service. To purchase health insurance directly from a health insurer, you may need to contact the company directly by phone, email or through its website.

Member Organizations & Member Health Plans

Member organizations and member health plans refer to groups of individuals who come together to purchase health insurance as a group. Member organizations can be labor unions, professional associations or other types of groups. By pooling their resources and buying health insurance coverage as a group. The members of these organizations can often access lower costs and more comprehensive coverage than they would be able to secure as individuals. This is because insurance companies are often able to offer lower rates to groups with a large number of members. To become a member of a member organization and be eligible for its member health plan, you typically need to meet certain eligibility criteria such as being a member of a certain profession, working for a certain company or residing in a specific geographic area.

Additional Health Insurance Plans

In addition to traditional health insurance policies, there are several other types of health insurance plans that individuals and families can consider. These include:

Gap insurance: A type of insurance that provides coverage for expenses that are not covered by a traditional health insurance policy such as deductibles, copayments and coinsurance.

Accident insurance: A type of insurance that provides financial coverage for expenses related to accidents such as emergency room visits, hospital stays and rehabilitation.

Critical illness insurance: A type of insurance that provides a lump sum payment if the policyholder is diagnosed with a critical illness such as cancer, heart attack or stroke. The payment can be used to help cover the costs of medical expenses and lost income.

Long term care insurance: A type of insurance that helps cover the costs of long term care services such as nursing home care, home health care and assisted living.

Short term health insurance: A type of health insurance that provides coverage for a limited period of time typically no more than 12 months. This type of insurance is often less expensive than traditional health insurance but also provides less comprehensive coverage.

Supplemental health insurance: A type of insurance that provides additional coverage for specific types of medical expenses such as prescription drugs or hospital stays.

It’s important to carefully consider your health insurance needs and budget when choosing the best health insurance plan for you and your family. You can compare the benefits and costs of different health insurance plans to find the one that is right for you.

Does Health Insurance Cover Dental Care

Health insurance coverage for dental care varies depending on the policy. Some health insurance plans include dental coverage as part of the policy while others do not. If a health insurance policy includes dental coverage, it may cover a portion of the cost of routine dental procedures such as cleanings, fillings and X-rays. More comprehensive dental coverage may also include coverage for major procedures such as extractions, root canals and orthodontics.

Most Common Health Insurance Scams

Health insurance scams are fraudulent schemes that target consumers in an effort to steal their money or personal information. These scams often take advantage of consumers’ confusion about health insurance and the Affordable Care Act and can result in financial losses and harm to consumers’ credit. Here are some of the most common health insurance scams:

Unauthorized billing: Scammers bill consumers for health insurance they never signed up for or bill them for more than the actual cost of their insurance coverage.

Unsolicited phone calls: Scammers make unsolicited phone calls offering consumers health insurance coverage and ask for their personal information including Social Security numbers and bank account information.

Phony insurance policies: Scammers sell fake health insurance policies that provide no actual coverage and disappear with consumers’ payments.

Phony government programs: Scammers claim to be representatives of government programs such as Medicare and offer consumers fake health insurance coverage in exchange for their personal information or payment.

Fake health insurance marketplace websites: Scammers create fake websites that appear to be the official health insurance marketplace and trick consumers into providing their personal and financial information.

It’s important to be cautious and do your research when considering purchasing health insurance. Before providing any personal information or making a payment verify the authenticity of the insurance provider and the policy.

How Medications Are Covered

Health insurance plans usually cover prescription medications but the specific medications and costs covered can vary based on the insurance plan. Most insurance plans have a formulary which is a list of medications that are covered under the plan and the cost sharing requirements for each medication. Some plans also require prior authorization for certain medications. Additionally, insurance plans may have different tiers of cost sharing for medications with some medications being placed on higher tiers and requiring a larger copay or coinsurance. It’s important to review the details of your insurance plan’s formulary and cost sharing requirements to understand which medications are covered and at what cost.

Why Health Insurance Is Expensive

Health insurance can be expensive for several reasons:

Lack of competition: In some areas, there may be limited competition among insurance companies which can lead to higher prices.

Administrative costs: The administrative costs associated with managing health insurance including claims processing, customer service and marketing also contribute to the overall cost of health insurance.

Rising healthcare costs: The cost of healthcare services including hospital stays, doctor visits and prescription drugs has been rising consistently leading to higher insurance premiums.

Advances in medical technology: Advances in medical technology and treatments can be expensive and insurance companies pass on some of these costs to consumers in the form of higher premiums.

Increased utilization of services: With the aging population and increased awareness of healthcare services, more people are using insurance to pay for their medical expenses leading to higher costs for insurance companies.

Overall, health insurance can be expensive because of a combination of factors including rising healthcare costs, advances in medical technology, increased utilization of services, administrative costs and lack of competition.


Health insurance plays an important role in protecting your health and financial well being. It helps cover the cost of medical expenses including doctor visits, hospital stays and prescription drugs. When shopping for health insurance, it’s important to consider the coverage, network, cost and out of pocket expensis to find a plan that meets your needs and budget. It’s important to review your insurance plan regularly to make sure it continues to meet your needs as they change over time.