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Understanding Health Insurance

What is health insurance?

The purpose of health insurance is to spread the risk of health care costs across a large population. You pay health care companies monthly payments (called "premiums") a set amount of money each month - and you get benefits to pay for your eligible health care expenses in return. 

In general, the higher the premium, the lower the out-of-pocket costs to the individual. 

What is covered under health insurance plans?

The costs that are covered range from routine doctor checkups to treatments for long-term illnesses.

However, ALL major medical plans sold nowadays must meet the requirements of the Affordable Care Act (ACA), including the "10 Essential Benefits:" These are:
  1. Ambulatory patient services (outpatient services such as doctor visits)
  2. Emergency services
  3. Hospitalization
  4. Maternity and newborn care
  5. Mental health and substance use disorder services, including behavioral health treatment
  6. Prescription drugs
  7. Rehabilitative and habilitative services (those that help patients acquire, maintain, or improve skills necessary for daily functioning) and devices
  8. Laboratory services
  9. Preventive and wellness services and chronic disease management
  10. Pediatric services, including oral and vision care

Even though it’s called individual health insurance, these also include plans to cover entire families. 

Why have health insurance?

Because health care can be incredibly expensive, it’s a smart idea to have health insurance so you’re prepared for medical expenses. 
And now, under the ACA, having health insurance is required by law. You may pay a penalty if you don’t have qualified health care coverage.

What if I can't afford to buy health insurance?

Assistance is available to help cover the monthly premium costs for those who fall within certain income ranges. It is well worth contacting a qualified insurance agency (such as Health Insurance Solutions!) to see if your income would allow you to be eligible for a tax credit to offset the cost of health insurance. 

At Health Insurance Solutions, we will help you with the entire application process from subsidy eligibility, to choosing a plan, to completing your insurance application. In most cases, this can all be completed over the phone.


Contact us today so we can assist you in getting the coverage you need.

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