No one plans to get sick or hurt, but most people need medical care – like a doctor visit, a prescription drug, a lab test, physical therapy, or counseling – at some point. These services can be expensive.
And if something happens that requires surgery or emergency medical care, it’s really important to have coverage. Fixing a broken leg can cost up to $7,500, and the average cost of a 3-day hospital stay is around $30,000.
What do health insurance benefits actually do for you? You probably hear about it all the time, whether on television, in magazines, and assorted other media. Health insurance is an extremely helpful part of life if you can set yourself up with a plan that will benefit you and yours for minimal cost. It’s meant to protect your financial assets, as well as promote wellness and health. There are an assortment of different perks and downfalls to each kind of health insurance plan, and it’s important to know what will help you and what won’t.
These essential health benefits include at least the following items and services:
- Outpatient care—the kind you get without being admitted to a hospital
- Trips to the emergency room
- Treatment in the hospital for inpatient care
- Care before and after your baby is born
- Mental health and substance use disorder services: This includes behavioral health treatment, counseling, and psychotherapy
- Your prescription drugs
- Services and devices to help you recover if you are injured, or have a disability or chronic condition. This includes physical and occupational therapy, speech-language pathology, psychiatric rehabilitation, and more.
- Your lab tests
- Preventive services including counseling, screenings, and vaccines to keep you healthy and care for managing a chronic disease.
- Pediatric services: This includes dental care and vision care for kids
Defining Health Insurance Benefits
The benefits of health insurance can be summarized as the services you receive from your health insurance company. Every company has an assortment of different plans that may or may not work for you. Most companies are also willing to work with you to determine your needs. You can have certain areas of your health insurance plans cover certain types of injuries or illnesses more specifically, so that you pay less for recurring things like office visits and medicine, or you can spread out your coverage as a more general purpose plan.
Single person plans have a smaller array of benefits and can be more tailored to the person they cover. A person that needs more extensive eye care coverage might eliminate some other options in order to afford a vision plan. These plans also cost less than family plans simply because there is only one person to cover.
You can also have family plans that will cover all the people in your family equally. These family plans are usually cheaper than having multiple single-person plans, and also have higher coverage rates that are shared among everyone in the family. Family plans can be customized in the way single-person can, but usually not as specific as a single person plan. So you need to consider, overall, if your family has a lot of office visits or not.
The way health benefits work is you get the bill, submit it to your insurance provider, (or have it automatically submitted to the insurance provider) and they will pay a certain percentage, or up to a certain amount that is dependent on plan. With most plans you will have to pay a deductible before the insurance will do anything. Frequently you will pay a co-pay at each office visit which is indicated up front. It is generally higher for a visit to a specialist than to your primary care physician. After that, the insurance will split the cost of the bill with you, typically with the insurance company paying the majority.