Basic Health Insurance Questions FAQ

Basic Health Insurance Questions FAQ

The issue of health insurance is both polemic and confusing for many people in today’s society, and for good reason; it’s a complicated subject, with many technical ins and outs. Basically, health insurance is an agreement with an insurance company that they will provide payment for health care expenses as needed. The insured pays for this coverage and certain aspects associated with it. Although there are going to be specialized details of any situation, here are some basic health insurance questions frequently asked and their responses.

What’s the difference between group and individual coverage?

The majority of Americans receive what is called group coverage through their employer or union, but individuals can purchase coverage for themselves. Individuals usually need to undergo a complete physical examination to qualify, and can be rejected because of their lifestyle, habits, or physical conditions. Group coverage is different in the fact that exams are not usually necessary and coverage is less expensive. This is because the costs are spread out among several members and employers often contribute to the cost as a benefit.

What are some of the things covered by insurance?

Insurance will generally cover preventative costs such as routine checkups and vaccinations as well as at-need issues linked to injury or illness, like medical equipment, hospital stays, medications, and therapies. Emergency room visits, ambulances, experimental treatments, and out-patient home care are often included as well, but not always. Under some circumstances, the insured must pay some portion of these costs out of pocket. Some plans include dental and vision coverage as well, depending on the type of policy.

What is the difference between deductibles, co-pays, and premiums?

A premium is the amount the insured pays for having the insurance policy; normally, this is paid on a monthly basis, and does not count toward medical expenses. A deductible is the amount the insured must pay toward care, whether it is a procedure, a hospital stay, medication, or equipment. Normally, the insured pays a fixed percentage of the total cost, and the insurance company covers the rest. A co-pay is similar to a deductible, but in a co-pay the insured is paying a basic cost for a service, such as a routine checkup or prescription medication; they usually range from $5-$50.

What is a “preexisting” condition, and how does that affect coverage?

A preexisting condition is an underlying medical condition which insurance companies often consider a “deal-breaker,” a serious medical issue that was not divulged to the insurance carrier prior to enrolling in the plan. The reason companies usually reject those with preexisting conditions is because these constitute a significant financial risk to the carrier. That is because these kinds of conditions are often more costly to treat, especially over the long term. Diabetes, congenital and metabolic disorders, mental illness, asthma, and heart problems are common preexisting conditions.

Health insurance doesn’t have to be a frightening subject, or a confusing one. Consumers can seek advice from medical and human resources personnel regarding the particular details of their situations and to get health insurance questions answered.  They can ascertain what health care insurance coverage is available for them, and get the answers to specific questions pertinent to their situations.  There is no reason to stay confused, however, because although every policy is different, the fundamentals typically remain the same.

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