Medical Insurance is intended to guard you from high medical costs. In the United States, many people obtain their insurance through their employer. Other countries such as Sweden, New Zealand and Cuba provide public health services to all their citizens. The U.S. government provides government-funded health services through Medicare and Medicaid, but only to those who qualify, such as the elderly and poor.
Coverage
A medical insurance policy contains a package of medical benefits that generally does not entirely eliminate out-of-pocket costs. Policies differ depending on the provider and the options your employer, or your family, chooses. FamilyDoctor.org wants you to know covered services may only consist of those deemed necessary by your doctor, and all necessary services may not be covered. Each insurance company decides which medications, tests, procedures and services it covers and which it does not. The website explains that if your doctor prescribes a service not covered by your medical insurance, you can file an appeal.
Deductible
Do not expect your medical insurance to cover every penny of your medical bills. A deductible is a pre-determined dollar amount you agree to pay for medical costs before your medical insurance begins to cover all or some of the costs. The U.S. Bureau of Labor Statistics explains the deductible may apply both per family and per individual. Read the fine print in your insurance agreement.
COBRA
In 1986 congress passed the Consolidated Omnibus Budget Reconciliation Act. When your employer provides your health insurance and you lose your job because of "specific qualifying events," COBRA goes into effect. According to the U.S. Department of Labor, the type of qualifying event determines which members of your family remain covered and for how long. Expect to pay a group rate, which is generally more than you paid previously because your employer no longer makes contributions.
Co-Payment
A co-payment is one way you and your medical insurance provider share costs. The insured pays a fixed price to receive a specific medical service. The insurance company pays the remainder. Co-Payments may vary according to service performed. Some insurance plans have both co-payments and deductibles while others have one or the other.
Pre-Existing Condition
Under the Health Insurance Portability and Accountability Act, a pre-existing condition is "one for which medical advice, diagnosis, care or treatment was recommended or received during the 6-month period prior to an individual's enrollment date." This means you can have a pre-existing health problem. However, you must not have received recorded medical treatment for it within the past six months. If your medical insurance company excludes you from coverage for a pre-existing condition, it cannot be for more than 12 to 18 months.
References
- U.S. Bureau of Labor Statistics: Definitions of Health Insurance Terms
- U.S. Department of Labor: FAQs for Employees About COBRA Continuation Health Coverage
- FamilyDoctor.org: Health Insurance, Understanding What it Covers
- United States Department of Labor: The Health Insurance Portability and Accountability Act
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