CHOOSING THE SERVICE TO SUIT YOU BEST
Health care can be very expensive. Having a baby costs about $30,000, and so does the average three-day hospital stay. Health insurance is a way to reduce those costs to an amount that you can manage by sharing the risk with others. That works because most people are healthy most of the time, so their premiums help pay for the expenses of the small number who are sick or injured.
Here are the major questions you need to ask when picking a plan.
What does the plan cover?
Insurance sold to people and small businesseses must cover 10 “essential health benefits." Any plan you buy, whether through your state's Health Insurance Marketplace or not, will pay for these services.
● Emergency services
● Hospitalization
● Laboratory tests
● Maternity and newborn care
● Mental health and substance-abuse treatment
● Outpatient care (doctors and other services you receive outside of a hospital)
● Pediatric services, including dental and vision care.
● Prescription drugs
● Preventive services (such as immunizations and mammograms) and management of chronic diseases such as diabetes
● Rehabilitation services
The rules for insurance provided by large employers are a little different but the vast majority them will cover the same set of benefits. To make sure, ask your employer for the Summary of Benefits and Coverage, a standard form that will state exactly what the plan covers and doesn't cover.
It's important to knowthat some older “grand-fathered” plans may not cover this same list of services. These plans were sold to individuals or small businesses (with up to 100 employees) that started before the new health reform law took full effect in 2014. Under certain circumstances, consumers were able to renew these plans even though they do not have all the consumer protections available with newer plans. If you have such a plan your insurance company will send you a notice about it before the annual renewal date. Then you can consider whether to keep it or switch to a new plan.
