Most people understand the value that health insurance provides, but individuals who rarely visit a doctor may question the need to carry coverage.
Despite costs and complexity that seem to rise each year, health insurance greatly reduces financial risk related to medical care. Even for healthy people, an accident or sudden illness can lead to significant medical bills.
Most health insurance plans also guarantee access to preventive care that can help keep you healthy. Annual checkups, colonoscopies and other important screenings typically are among the preventive care services covered under most plans.
We’ve compiled some of the most common health insurance questions and answers to help you understand your coverage.
What Type of Health Insurance Do I Have?
Health insurance is available in two primary types. Health maintenance plans offer lower costs but sometimes limit the doctors and other medical professionals you can see. If you choose an HMO plan, you’ll select a primary doctor and will need referrals to visit other specialists.
Preferred provider organizations, or PPOs, are the most-used type of plans. You won’t need to select a primary doctor or get referrals, but you’ll pay more.
Other types of plans exist, but most people are covered under HMOs and PPOs.
What Are Deductibles, Copayments and Coinsurance?
These three terms refer to the covered costs for which your plan pays. Your deductible is the amount you’ll pay for certain services before your plan coverage kicks in. Regardless of meeting your deductible, you’ll pay a specified, usually minimal copayment for each medical service you receive.
Coinsurance refers to the percentage of your total medical costs you’ll pay once you meet your deductible. In addition, the out-of-pocket maximum refers to the highest total costs you may pay in a year.
How Do High-Deductible Plans Work?
High-deductible health plans generally work well for healthy people who need minimal medical care. If you have this type of plan, you’ll pay less in monthly premiums, but you may pay a significantly higher deductible should you have a serious accident or illness for which you need care.
High-deductible plans often cover preventive care such as regular checkups and certain screenings that are not included in the deductible. Many people set up a health savings account, or HSA, to use in conjunction with a high-deductible health plan.
Can I Get Coverage Through Medicare or Medicaid?
Medicare is the government health insurance program for people age 65 and older; it’s important to enroll as soon as you’re eligible. Through Medicare, you’ll receive hospital insurance at no cost, medical insurance for a monthly premium, and prescription drug coverage.
Medicare Advantage Plans replace traditional Medicare coverage and limit the annual maximum you may pay for your medical services. After you reach the limit on out-of-pocket costs, you pay nothing additional.
Medicaid is a federal health coverage plan for families and individuals with limited incomes. If you cannot afford health insurance, you may be eligible for coverage under the Medicaid program. For more information, contact your county social services department.
Does My Plan Cover Colonoscopies?
Screening colonoscopies typically are performed on healthy individuals to detect possible colorectal polyps or colorectal cancer. Medicare and most private insurers cover such diagnostic services without charging you a co-pay or requiring that you meet your deductible first.
To learn more about our services, insurance coverage and financing options, please contact Northeast Digestive Health Center.
