4 Facts about Health Insurance

Updated on July 21, 2021

Learning about health insurance coverage and your options is essential to ensure you have access to the best possible healthcare for your needs. It can also be rather difficult to understand everything about health insurance. Here are four facts about health insurance to help you get started.

1. Variation by State or Region

There are many regional and state variations in healthcare insurance coverage and providers. Across your state or region, you may be able to visit many different in-network providers who will accept your insurance, but the farther away from home you go, the less likely you are to find healthcare providers in your insurance network. It’s vital that you review your insurance plan and check whether it’s accepted anywhere close to your destination whenever you travel so you can be prepared. Massachusetts health insurance providers may be different from providers in Arizona, for example, so if you were moving from Arizona to Massachusetts, you would need to check whether your policy could be transferred or you would need to switch to a new provider.

2. Changing Your Insurance Plan

Generally, you can only make changes to your insurance plan once annually, during the enrollment period set by your private or government health insurance provider. However, there are some exceptions. The most well-known are qualifying life events. These include income changes, marriage, purchasing a home and having or adopting a child. You can report these changes to your provider and update your plan accordingly. Another common exception is when someone gets a new job and therefore switches insurance providers.

3. Preventive and Emergency Coverage

One of the things you’re most likely to need to understand about health insurance is the difference between preventive and emergency coverage. Preventive care is generally only covered if you see an in-network healthcare provider. There are also certain restrictions on how often you can access preventive care. Generally, your insurance provider will cover annual exams for general checkups, gynecological exams and eye exams, as well as routine blood tests and similar services. You’ll likely be responsible for small copays at each appointment. Emergency coverage, on the other hand, tends to be much more flexible due to the nature of emergency medical care. While the copays tend to be higher and you may need to meet your deductible before your insurance provider will begin covering expenses, you aren’t required to go to an in-network emergency room or urgent care center. This ensures you can access emergency care whether you’re near your home or far away.

4. Specialist Care

Every insurance provider will have different allowances for specialist care. While most will allow you to seek specialist treatment for things like endocrinology and oncology, your plan may not cover eye exams and prescriptions lenses or dental and orthodontic care. You may need to purchase separate insurance plans for these healthcare needs or add additional coverage to your existing plan.

While you don’t need to be an expert in health insurance by any means, knowing the basics of coverage, as well as the intricacies of your own insurance policy, can be incredibly helpful.

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