Health insurance is a benefit most workers receive as part of their job. This insurance helps reduce expenses for medical services, such as outpatient surgery, prescriptions, and checkups. The employer pays for some or most of the premium, and the employee’s contribution comes from their pay.
Companies that provide health insurance have agreements with specific doctors and medical facilities. This is the network, and a policyholder must receive medical treatment within that network. Going out of the network usually means health insurance will not pay. That means a doctor’s visit will cost more if going outside of the network. Say that a doctor charges $85 per visit. People within the network might get a reduced rate, for example $60. The insured person has a co-pay of $25, and the insurance company picks up the balance of $35.
Employers have different plans available. All plans are set so that the policyholder must meet a certain deductible before insurance pays. This is the “maximum out of pocket.” When the policyholder pays the deductible and the maximum out of pocket amount, the insurance company pays for the rest.
Note that the deductible is not the same as the co-pay. The co-pay is upfront payment for medical treatment. It is not a part of the deductible. The deductible is something you would pay in addition to the co-pay. You may receive a bill later that counts towards the deductible. However, the co-pay is due the same day you receive service.
The Affordable Care Act makes it mandatory for insurance companies to pay for preventative services. You may have to search for a policy that has co-pay, deductible and other costs that you can afford. The benefit of coverage is that for your monthly premium, you have coverage in case of a catastrophic accident. A good policy means you will not face a huge medical bill.
Insurance through an employer is the best way to get good coverage. However, people without coverage can purchase a personal health insurance policy.