Things You Need To Know About Medical Insurance (Healthcare Counseling Discussion)

Are you deciding which insurance plan to choose? Do you know how much it is going to cost you with your treatment? Are you concern that you might not get the right amount of benefits you deserve when the time comes you need it? Do you know what your options are? Unfortunately, despite a lot of open information about medical insurance, acquiring it is not so simple. Sometimes, when you chose the wrong one, you pay a lot of cash towards your healthcare. You end up wasting some of your hard-earned money only because you do not understand how medical insurance works.


What Is Health Insurance?

Health insurance is an arrangement between a policyholder and an insurance company. It aims to provide financial assistance for you to afford the costs of any medical concerns. In addition, health insurance improves access in the healthcare system to allow you and other people to seek and pay for healthcare services.

Type Of Insurance

  • Government-Sponsored Health Insurance – Medicaid and Medicare are the known Government-Sponsored Health Insurance. These are obtained through a program that caters to a specific group of people such as active service members, children, veterans, the elderly, and low-income people.
  • Group Health Insurance – It is a commercial insurance plan supporting employer-based insurance that offers discounted coverage for mostly healthy working individuals. The good thing about this is the split of premium payments between the employee and employer.
  • Individual Health Insurance – It is also a commercial type of insurance covering a single person or family needs. The premium coverage of the healthcare is paid entirely by the purchaser. This type of insurance varies as it points too much to the age of the purchaser. Unfortunately, it typically offers fewer amounts of benefits compared to group insurance.

Of course, there are instances that the insurance company pays a lot more. But that depends on the specific categories such as premium, deductible, and out-of-pocket maximum. These may sound so complicated, but it is typically not that hard to understand as you think. So with that, here is some of the basic information that might help you understand medical insurance better.

The process of acquiring insurance usually starts in three basic processes. The first one is you have to pay for your medical bills, and then the insurance will pay you back after. The second is when both you and your insurance company pay some amount to cover the medical bills. The third is when the insurance pays everything.



Premium insurance can be compared to a membership. You pay a specific amount of money monthly to be a member, and that’s your premium. With that exact amount, you get to acquire preventive care benefits for free, particularly vaccines. You can also get free screening for certain conditions such as cholesterol, diabetes, and even breast cancer. A premium covers all these medical benefits.

However, the benefits you may acquire may vary if you need more than just preventive care. You will know if what you need is beyond preventive care limits when you need treatments for certain severe illnesses, immediate surgery procedures, confinement, and emergency room visits. You need to pay an extra amount of cash only to support your medical needs in some unfortunate instances. If you’re asking how much, that depends as the medical fees change over time.


If you haven’t noticed it yet, you usually pay most of your healthcare at the beginning of the year until each of your deductibles. A deductible is the amount of money you need to pay to the insurance company before they could share with you the costs of your financial contributions. It is like filling up a bucket. You usually pay a copayment only for covered services, and the insurance company pays the rest.

Once you reach your deductible, you immediately enter into the next stage. That is where your insurance company shares the costs of your medical or healthcare needs every time you receive healthcare services. But the amount the insurance company will pay depends on the insurance plan you signed up for.


Out-Of-Pocket Maximum

Paying for the insurance has its benefits. If you reach a certain amount, you will never have to pay for any healthcare services anymore. Note that the insurance company keeps records of your contributions, but the out-of-pocket limit doesn’t include your premiums in the bucket. An out-of-pocket maximum is the set of money you will have to pay in one whole year on covered medical or healthcare costs. But it is essential to understand that there is a possibility that you might end up paying more than the required out-of-pocket maximum in a given year.

But once you finally reach your limit, the insurance company will pay everything from there for the rest of the year. But put in mind that the process starts over every year. Meaning, you will go back to the first process and meet your deductibles again.


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