Depending on your budget and medical needs, you likely have some kind of health insurance plan. And while plans vary, most offer the following essential health benefits:
- Outpatient services
- Emergency services
- Hospitalization
- Maternity and newborn care
- Pediatric services
- Mental health and substance use disorder services, including behavioral health treatment
- Prescription drugs
- Rehabilitative and habilitative services and devices
- Laboratory services
- Preventive and wellness services and chronic disease management
Some of these benefits, such as preventive services, are paid fully by the insurer with no copay (additional payment). However, depending on your plan, you may still be responsible for paying a copay and coinsurance fee.
What are the advantages of health insurance plans?
Health insurance is one of the most important purchases you will make, so it’s important to thoroughly understand the key advantages of a health plan, which include:
- Cashless hospitalization
- Most top insurers have an extensive list of network hospitals all over the country. If you are suffering from a health problem and get admitted to an in-network hospital, you will most likely be able to take advantage of cashless hospitalization.
- This eliminates the traditional claim reimbursement process where you were required to first clear hospital dues and then get them reimbursed from the insurer.
- With cashless treatment, the insurer directly pays medical bills to the hospital. Thus, you will not be required to bear the high treatment costs.
- Financial protection
- The biggest benefit of purchasing health insurance is that it prevents erosion of long-term savings. Because of the rising costs of quality health care, having health insurance means you can avoid one accident or health problem from creating unmanageable debt.
How does health insurance work?
The idea of health insurance is simple: Medical care can be expensive, and most people can pay for it out-of-pocket.
However, if people get insurance as a group, then each person pays a fixed amount every month (even if they don’t need medical care at that time). The risk (such as copay or coinsurance) associated with the insurance plan is also shared by the group. Each person is therefore protected from high health care insurance costs because the burden is shared by many.
Health insurance is now required for everyone in the United States. People who don't have insurance have to pay penalties that increase each year.
Parents can keep their children on a family plan until they are 26 years old. After that, their children will have to get health insurance on their own or through their employer.
What is Medicaid vs. Medicare?
Medicaid
Medicaid is a public state and federal combined health insurance program, which provides health insurance coverage to low-income children and adults who meet certain eligibility criteria. State Medicaid programs may go by different names.
Medicaid covers more mental health and substance use disorders services than Medicare. Eligibility for Medicaid varies in every state, but federal law requires states receiving federal funds for Medicaid to cover:
- Pregnant women and children (younger than 6 years of age) with family income below 138% of the federal poverty level (FPL).
- Children ages 6-18 years with income below 100% of the FPL.
- Parents who are below the state’s welfare eligibility level (often below 50% of the FPL).
- Most older adults and individuals with disabilities, including mental illness, receive federal SSI (generally, 75% of the FPL).
Medicare
- Medicare is a federal health insurance program that provides coverage similar to private health insurance. Medicare does not cover a broad range of community-based services for people with mental illness. Eligibility criteria for Medicare may include:
- People age 65 years or older.
- Adults with disabilities who have received Social Security Disability Insurance (SSDI) benefits for at least 24 months.
- People with low income (generally 75% of the FPL) and limited assets who are enrolled in Medicare may also be eligible for Medicaid coverage (dual eligibility). They can take advantage of benefits from both types of insurance.
- People with end-stage renal disease.
- 190-day lifetime limit on psychiatric hospital care.
SLIDESHOW
See SlideshowHealth Solutions From Our Sponsors
Centers for Medicaid and Medicare Services. Information on Essential Health Benefits (EHB) Benchmark Plans. https://www.cms.gov/CCIIO/Resources/Data-Resources/ehb
Top What Are Examples of Health Benefits? Related Articles
Affordable Care Act (ACA)
President Barack Obama signed the Affordable Care Act (ACA) into law on Mar. 23, 2010. The Affordable Care Act aims to control health-care costs, improve how health care is delivered, and reduce the number of uninsured individuals.What Questions Should I Ask My Doctor About Breast Cancer?
A diagnosis of breast cancer can be overwhelming, so it's important to write down all your questions before meeting with your doctor.Dizziness: When To See a Doctor?
Patients who continue to have repeated episodes of dizziness need to consult with a doctor.Drugs: Questions to Ask Your Doctor or Pharmacist about Your Drugs
Important information about your drugs should be reviewed prior to taking any prescription drug. Side effects, drug interactions, warnings and precauctions, dosage, what the drug is used for, what to do if you miss a dose, how the drug is to be stored, and generic vs. brand names.13 Lies You Tell Your Doctor
Are you honest with your doctor? You should be, if you want to stay healthy. Check out WebMD's slide show for the 13 lies you're most likely to tell your doctor.Is Nightlase Covered By Insurance?
Currently, most of the insurance companies do not pay for snoring treatments as an isolated problem. Because NightLase is a simple laser procedure without the use of any anesthesia or heavy equipment, insurance does not cover its cost.Why Does Your Doctor Do That?
Your physical exam is when you need your doctor's expert help. Your health depends on it. Learn how doctors spot high blood pressure, STIs, various cancers, and other signs of poor health. What questions should you ask your doctor? Find out here.Senior Health: Ways to Stay Healthy in Retirement
You can do some things to make your golden years truly golden. Here are a few ideas to help you prepare for -- and have -- a healthy retirement.What Kind of Doctor Do I Need? Find a Specialist
Do I need my primary care doctor or should I see a specialist? Finding the right doctor is daunting. We make it easier, explaining medical specializations like rheumatology, endocrinology, oncology, and more.What Type of Doctor Is A Proctologist?
A proctologist is a surgeon who specializes in diagnosing and treating disorders of the lower digestive tract, which includes the colon, rectum, and anus. Currently, proctologists are referred to as, “colorectal surgeons” or “colon and rectal surgeons.”When Should You Go to the Doctor for Hemorrhoids?
If you're dealing with painful or bleeding hemorrhoids, you're not alone. About one in 20 Americans have hemorrhoids, and that includes half of all adults over age 50.When to Call the Doctor for Your Headache?
Almost everyone must have experienced a headache at some point in their life. The most common reasons for your headache are migraines, tension headaches, cluster headaches, and sinus headaches. Headache is also most often experienced in some common viral infections such as the flu or even in something as simple as the cold.