Know Your Policy – The Basics of 2019 Health Insurance

Health insurance is essential for peace of mind, and for providing options when you need medical care. While every health insurance policy covers emergency services, there are myriad other health consultations and procedures that can be covered under different plans.

To be able to properly compare the best 2019 health insurance plans with your needs in mind, you’ll need to know exactly what a plan could cover, and why you need one.

It All Starts with the Policy

Every health insurance policy is a form of contract. It is a legally binding agreement between you and an insurance provider that will determine the type of benefits you receive while the policy is active. Before you sign up to a health insurance policy, you will be given information such as treatment services that are covered, where you can avail the services, whether medications are covered, and the type of tests and screenings that are covered by insurance.

In addition, the initial information package will also tell you specifically the type of care that is not covered, and in which circumstances.

For anything not covered by your insurance, you will need to shoulder the total costs. This is why it’s so important to carefully compare your options and choose the most comprehensive plan possible within your budget.

The Basics of Health Insurance Coverage in 2019

You probably already have a health insurance plan that covers you for 2018. You can use this as a base point of reference. Were there medical services that you needed and that wasn’t covered by your policy? Or, did you find that your policy was too expensive and provided more coverage than you actually used?

Buying the right insurance is a delicate balancing act. While you need to ensure that you have the right amount of coverage for emergencies and general medical treatments, you also need to make sure that your insurance is affordable.

Health InsuranceEven with the most basic insurance package, you can usually expect to receive some essential health benefits. These are standard coverage items that come packaged with insurance, and sometimes there will be no additional fees associated with them (outside of your standard premiums/deductible).

The essential insurance benefits can include:

  • Drugs as prescribed by your doctor.
  • Hospitalization.
  • Ambulance services.
  • Emergency care services following an accident etc. (all insurance offers coverage for emergency care).
  • Rehabilitation coverage.
  • Lab services (for blood work, urinalysis etc.)
  • Pediatric services for infants, children, and adolescents.
  • Preventative screenings and immunizations.
  • Counseling and psychotherapy (limited circumstances, so be sure to check your policy).
  • Maternity care, including prenatal and postnatal care.

The above benefits are guaranteed when you purchase insurance that is federally backed. Some states design their own essential health benefits that are offered by insurers. It is important to check the essential benefits whenever you are comparing a policy. If you move around often, then you will need to look for any clauses that would impact your essential health benefits when you are traveling out of state.

Keep in mind that some insurers will offer extended essential benefits that are covered by the policy with minimal or no out of pocket costs at the point of service. If you purchase a premium insurance plan, then you can usually expect to receive extended benefits.

Preventative Services Can Vary from State to State

Preventative services are those designed to protect you from future health problems or to diagnose warning signs that you may be developing a disease or another medical condition. These services vary by age and where you live. States can mandate the basic preventative services that insurers must offer. Again, this is something you need to look at closely in your policy.

Examples of preventative services can include seasonal vaccination, HIV screening, breast cancer and cervical cancer screening, prostate cancer screening, and various cardiac tests used to screen for heart problems.

Coverage Outside of Your Policy is At the Insurer’s Discretion

Your policy will outline all the essential medical benefits, including screening services, as well as consultations and procedures that are covered in your policy. Of course, with medical care being highly complex, there will be times when you are referred for a type of medical service that is not explicitly outlined in your policy.

It is your doctor who ultimately decides what kind of treatment, screening, or procedure is needed in your unique case. If you are using medical services within the network of doctors and hospitals in your policy, then your doctor will have extensive knowledge of the available coverage. If you are going outside of the network (such as with a PPO insurance policy), then your doctor may not have the same kind of understanding of what is covered by your insurance.

Even though your doctor decides upon the care that you need, it will be your insurance company that decides what is covered by your policy. In some cases, care that is not specifically defined in your policy can still be covered. This is entirely at the insurer’s discretion. Insurance companies have extensive knowledge of medical procedures and can usually determine appropriate treatment paths based on medical coding in your health record.

While many people assume that insurers are simply out to make money, you could be surprised by the flexibility they can offer when it comes to your health.

Compare the Best Insurance Coverage Options for 2019

You can enroll for you 2019 health insurance between the 1st of November and 15th of December this year. Now is the time to start considering your options, and Mutual Health Partners is the best place to compare plans while getting access to the most affordable insurance.

Our licensed insurance specialists will present you with the ideal policies based on your needs and your budget. Buy cost-effective health insurance that gives you complete peace of mind today.