The Possible Limitations of Your Health Insurance Coverage

Most people place their health toward the very top of their priority list. Many people who can afford to do so subscribe to health insurance plans to help them afford the cost of the medical care that is necessary to keep them healthy. Since health insurance is not always affordable many Americans are uninsured. The problems this creates are well documented and often reported on, with good reason. They are very serious and can be life threatening. However, it is also important to discuss the issues of people who do carry health insurance because there may be issues with their health insurance coverage that create significant gaps in care and serious health concerns for the policy subscriber and his or her family.
Before you sign your health insurance documents and start paying your premiums, it is important to understand the details of the plan that you are purchasing including:
  • Your Deductible and Co-Insurance Rates. Some health insurance policies require you to pay a deductible before your coverage begins. The size of the deductible can range from a few hundred dollars to thousands of dollars, depending on your policy. Some plans have participants pay a co-insurance amount once they have met their deductible. During the co-insurance period the insurance company pays a percentage of the medical costs and the insurance holder pays the other percentage.
  • Your Prescription Coverage. Some health plans include prescription coverage and others do not include your cost for prescription drugs. It is important to understand whether your plan covers your prescriptions and what the out of pocket cost to you will be after your prescriptions are filled.
  • Your Coverage for Hospital Stays and Medical Procedures. Most people want their doctors, not their health insurance companies to make their medical decisions. For example, you want your doctor to decide how many days you need to remain in the hospital following surgery based on your unique circumstances. You do not want your health insurance company to make that decision for you. If your health insurance policy has a customary number of days it allows a patient to remaining the hospital following certain types of surgeries or procedures then you want to understand how your doctor can seek to override that and have your insurance company pay for any additional time that it is medically necessary for you to remain in the hospital.
  • Your Coverage for Pre-Existing Conditions. Many health insurance plans exclude coverage for pre-existing conditions. That means that if you have cancer, diabetes or even if you are pregnant, it can be difficult to purchase a new health insurance plan that will cover the costs of the condition that you know you have at the time you are signing up with that health insurance company. The costs for treatment can be astronomical without health insurance.
You never know when you are going to need your health insurance to pay your medical bills. You may be young and healthy and not anticipate a medical problem. However, all it takes is one car accident or one birth injury to put you into personal bankruptcy. Therefore, it is important to understand just how comprehensive your health insurance is and to make an educated decision about whether it will meet your needs now and in the future.

The information on this page is meant to provide a general overview of the law. The laws in your state and/or city may deviate significantly from those described here. If you have specific questions related to your situation you should speak with a local attorney.

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