What is health insurance?
Health insurance is a type of coverage that partially pays for your health-related costs. Unlike car insurance, you don't have to have health insurance. However, it is important to have some form of insurance to protect you from bearing the costs of prescriptions and medical care on your own.
You make a fixed payment to your health insurance company every month. This is called a monthly payment. In return, your health insurance company will cover a percentage of your Medicare costs after you meet your deductible amount. A deduction is the amount of money you need to spend before your health insurance kicks in and begins to cover your expenses. Once you meet your deductible, you only need to pay your coinsurance, which is a small percentage of your costs of care.
For example, let's say you have a deductible of $ 3,000. You will have to spend $ 3,000 out of pocket on your care before insurance can cover it. If you have 20% coinsurance, your insurance will pay 80% of your medical bills after the deductible is paid. You must pay the remaining 20% out of pocket.
Average cost of health insurance in Florida
The average Florida citizen pays about $ 393 a month in health insurance premiums if they have an individual plan. The average premium is $ 1,021 per month if you have a family plan. However, the exact amount you will pay for coverage depends on a number of factors, ranging from whether or not you smoke to the type of plan you have.
Types of health coverage
There are many types of health insurance plans. The type of plan you choose will determine how much you pay and whether you need a referral to see a health care provider and professional you can see. Let's review the three most popular types of health insurance plans: HMO, PPO, and POS.
- HMO plans: HMO plans require that you see only doctors, specialists, and caregivers within the organization's network. You cannot see any out-of-network healthcare provider and must get a referral to see a specialist. HMOs are the most affordable type of plan, but they give you the least amount of freedom to choose the caregivers you see.
- Preferred Provider Organization (PPO) Plans - PPO plans offer a network of doctors and professionals, but they don't require viewing. You will pay an additional fee if you see a healthcare provider outside of your network. You do not need a referral to see a professional who has a PPO. PPO plans tend to be more expensive than HMO plans.
- Point of Service (POS) Plans - Point of sale plans are a mix between HMO and PPO. You can see doctors and specialists outside of your network with a POS plan, like the PPO. However, you will still need a doctor's referral to see a specialist as you would the HMO. Point of sale plans can allow you to see the caregivers you want at lower prices than PPOs.
What does health insurance cover?
Each health insurance plan can include or exclude any type of coverage it wants before the ACA is introduced. This made comparing plans incredibly tedious because there was no standard of coverage among the dozens of options. The ACA now dictates that any permanent health insurance plan must include at least the following ten "basic benefits":
- Outpatient Services - This is outpatient care that you receive outside of the hospital.
- Emergency Services - Your health insurance provider should cover emergency care at any hospital, regardless of whether the hospital is in-network or not. Similarly, your health insurance provider cannot ask you to contact the hospital before you receive emergency care. You should visit the hospital closest to you in case of a real emergency.
- Hospitalization: This includes things like an overnight stay, medications prescribed by a doctor or nurse, as well as surgeries.
- Care during pregnancy, maternity and newborn: includes prenatal and postnatal care. It also includes complications of labor and pregnancy.
- Mental Health and Substance Abuse Treatments - The health insurance provider must provide coverage for behavioral therapy, inpatient mental health services, and substance abuse treatment. Your health insurance provider cannot set a lifetime or annual limit for the treatment of a specific disorder or substance use problem.
- Prescription Drugs: Although health insurance providers can't rule out prescription drug coverage, they may ask you to try less expensive general remedies before moving to more expensive or habit-forming drugs. This is called "step therapy."
- Rehabilitation services and devices - This includes things like physical therapy, occupational therapy, and mobility devices.
- Lab Services - This includes outpatient blood tests and pictures that you receive in a medical facility or hospital (such as X-rays or upper GI scans).
- Preventive Services and Health Checkups - This includes things like physical checkups, shots, and booster shots. Many health plan providers offer these services for free.
- Pediatric Services - Health insurance plan providers must provide health, vision, and dental services for the children in their plan. However, dental and vision benefits are not required under the ACA adult plans. You may be able to purchase additional plans through your insurance provider.
Your plan should also include the following benefits for women:
- Lactation support: includes counseling and equipment for nursing mothers.
- Birth Control: ACA-compliant plans must include prescription and FDA-approved birth control. This includes emergency contraception, but does not include drugs intended to terminate an already viable pregnancy.
Your employer may be exempt from covering some contraceptives if you work in a place of worship or a non-profit religious establishment.
What does health insurance not cover?
Most health insurance plans do not cover the following benefits:
- Male birth control: Most plans do not include barrier or vasectomy methods because female-only contraception is a main feature.
- Travel vaccinations - Your insurance company should cover only medically necessary routine vaccinations. Travel vaccinations are generally considered an optional preventative and most plans are not covered by them.
- Dental and Vision Coverage: Only insurance providers should cover these services for the children on your plan. If you want to cover adults, consider purchasing an additional plan.
- Weight Loss Surgery - No federal state requires insurance providers to cover bariatric surgery. However, many insurance companies choose to include this coverage. If you or someone in your plan needs bariatric surgery, be sure to check with your representative and make sure it's covered before you sign up.
- Plastic Surgery: There is no type of health insurance plan that covers plastic surgery because these procedures are not medically necessary.
Unless a specific treatment is a primary benefit, most insurance providers will not cover it. These are just a few of the treatments and services that are generally not covered. If you are concerned about coverage for a particular treatment or service, contact your health insurance provider and ask about it.
Cheap Health Insurance in Florida:
- Best Overall in Florida: Aetna
- Cheapest Health Insurance in Florida: Humana
- Best for Fixed-Incomes: Florida Blue
- Best for Prescription Coverage: Cigna
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