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The Ins and Outs of Health Insurance

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Health insurance and various policy options can be pretty complicated. But knowing what your health insurance plan can do for you is a great first step in making the most of your coverage. When getting your mind around the basics of health insurance, these are the top areas you’ll want to understand:

What is overall coverage for?


In America, the three major types of health insurance coverage are Medicare, Medicaid, and private insurance.

A Medicare health plan is for seniors or people who receive SSDI benefits for a disability after established employment history. Medicare covers up to eighty percent of most medical expenses in a hospital or doctor’s office and costs an optional monthly payment taken from SSDI checks. Most doctors take Medicare, especially when patients have additional coverage through supplemental or advantage plans.

Medicaid is for lower-income adults and children, free of charge, and covers the bulk of nearly all medical expenses including prescriptions. But because of reimbursement rates, some doctors do not take Medicaid clients.

Private insurance is paid for by individuals and coverage options are nearly limitless; the more you want, the more you pay for. Private insurance is also available to families through the Affordable Care Act in the open marketplace.

When it’s time to find the best hearing aids for the money you’ll need to do the best with what you’ve got for coverage. While most plans would pay for hearing aids because they are considered medical necessities, prescription coverage, deductibles, and other factors would all play into your out-of-pocket cost of hearing aids.

The example above is exactly why health insurance is important. While you may not have problems with your inner ear or even need a hearing aid at all, the same would be true for conditions not unrelated to hearing loss. That is, if you were to develop an acute and serious illness, you could be looking at very different levels of coverage depending on what kind of insurance you have. If you had no insurance at all, you could be left with the entire bill or looking at months of working with financial services and still being stuck with a devastating final medical bill. For this reason, it’s important to understand your insurance and pick up extra coverage where you can.

Health Insurance Claims and Deductibles


Filing health insurance claims can be a nightmare. An insurance claim denial could mean months of waiting for a final decision or external review and enlisting the help of professionals to assist you after a health insurance claim denial. For this reason, you want to make a good choice with any doctor you select as you may need their help in the claim process. The same applies to your health insurance company. If you are selecting a plan of the open marketplace, you’ll want to ask questions about their claim policies during enrollment periods. Advocating for yourself and finding out all the information ahead of time could save you a lot in the future.

When selecting an insurance plan, it’s best practice to compare coverages and select an affordable option with a deductible you can cover. That is, you want to know you’ll have whatever that deductible is in a savings account or other assets before enrolling. Some policies won’t allow claims to kick in until you’ve met those deductibles—this is particularly true with prescription coverages. Find out ahead of time about payment plans, time frames for approvals, spending limits, and whether they’ll cover your medication.

Prescription Plans, Coverage Options, and Add-ons


No two health insurance providers are exactly alike. When doing your shopping, ask for an explanation of benefits, what would happen if you got in a car accident, and how prescription coverage and deductibles work. While you’re doing your research, ask about what other benefits your potential plan offers. Some health insurance companies provide members with free gym memberships or smoking cessation classes as a perk for sickness prevention.

Before you jump to the first company you can afford, find out what a claim denial would look like, the period of time you’re expected to wait between wellness appointments, and even how that company handles simple errors on claims. One of the best ways to get optimal medical care is to fully understand your plan. Doing the research now could mean the difference between the future denial of your claim and be on your way to a financially stress-free recovery.