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Medical Insurance

Health Insurance, also known as Medical Insurance, pays expenses related to the treatment of covered illnesses or injuries.  However, as with most things, Health Insurance can be much more complicated than that. Health Insurance policies can contain a dizzying array of exclusions, deductibles, co-pays, coverage limits and treatment restrictions. Below is a brief explanation of some of the basics of health insurance.

Insurance Agents can help you understand what types of insurance policies you need, what types of coverages are available, what exclusions to avoid as well as find you the best policy and price. 

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Currently, most Americans with Health Insurance get their health insurance through their employers. Health insurance plans offered through employers are known as Group Plans because your eligibility is dependent upon your inclusion in a specific Group, in this case your employer. Group Plans are very advantageous because you are automatically covered upon payment of the premiums based on your inclusion in the group and you cannot be denied coverage because of your past or current health condition. Many times, an employer will pay a portion of the health insurance premiums and the employee will pay the remainder. The percentage paid by the employer is decided by the employer and can range from 0% - 100%. In addition to employers, other types of groups can also offer group health plans.

It is important to remember that employer group health plans are sponsored by the employer but they are run and administered by private insurance companies. In the event of a claim, you will deal directly with the private insurance company that wrote your health insurance policy, not your employer. In most cases, your employer will have no decision making ability in whether a claim is paid or denied.

Many other Americans are covered by Social Insurance plans. Social Insurance plans are insurance plans run by the government such as Medicaid or Medicare. Their benefits and coverages are determined by the government, not private insurance companies. They normally cover certain populations such as the elderly, the very young, the disabled or the poor. Social plans are paid for entirely with public taxes and their benefits are government for local, state and federal governments.

You can also obtain insurance directly from a private insurance company. But unlike Group and Social plans which cannot deny you coverage, a private insurance company can refuse to cover you with a policy if you are already in poor health. In addition, private policies are generally much more expensive to obtain than most group policies. Therefore, if you have access to an employer sponsored health insurance plan, that is generally the best and most cost efficient way to obtain health insurance.

Affordable Care Act

The Affordable Health Care for America Act was a law passed by Congress in 2009 and implemented in 2014. It has a number of different provisions but its major accomplishments were to:

  • Prohibit Health Insurance Companies from denying coverage to individuals based on an individual’s past medical history.
  • Establish minimum coverage standards that each insurance policy must meet.
  • Create subsidies to help low income individuals afford health insurance policies.
  • Create a public ‘health insurance exchange’ where consumers can go to compare coverages and prices among different health insurance companies.

For a complete description of the law, please visit https://www.healthcare.gov/where-can-i-read-the-affordable-care-act/.