10 Things You Need to Know About Health Insurance in the United States

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Updated: 13 June 2023
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Insuranceopedia Staff
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Key Takeaways

  • Understanding how health insurance works is the first step to getting the coverage you need.

Getting sick is bad enough, but the expense of getting treatment can put a real strain on your finances. Health insurance, thankfully, can help you get the medical care you need without breaking the bank—if you have the right kind of coverage.

Here, we’ll go over the 10 things you need to know to make sure you understand how health insurance works and that you have the right kind of protection in place.

1. Health Insurance Is Mandatory

The Affordable Care Act (also known as Obamacare) has transformed the American health insurance market by setting up new rules for coverage. One of these new rules is that everyone must have health insurance coverage. If you don’t have coverage, the IRS will charge you an extra tax penalty for each month that you go without it.

2. Buying Insurance Has Gotten Easier

Buying insurance used to be kind of a scary experience. Insurers usually required you to get a physical and would look over your medical history as part of your application, and could deny you coverage based on whet they found.

The Affordable Care Act made buying coverage a lot easier. Under the new rules, insurers can’t deny you coverage based on your medical history.

3. You Can Only Buy Coverage at Certain Times

You can’t buy health insurance whenever you want. Instead, you need to meet a qualifying condition to buy a policy. First, you can buy a policy every year between November 15th and February 15th. You can also buy coverage after certain events like losing coverage because you left your job or you had to leave your parents’ insurance plan (find out What You Need to Know about Health Insurance Before Quitting Your Job).

4. There Is a Wide Range in the Quality of Coverage

Not all health insurance plans are built equal. More expensive plans generally offer more coverage and charge fewer out-of-pocket fees throughout the year. A less expensive plan might restrict the medical providers you can see and will most likely charge you other fees throughout the year. Make sure you understand exactly what a plan covers before signing up.

5. Your Premiums Won’t Be Your Only Expense

To keep your health insurance in force, you need to pay a monthly premium. But this won’t be your only expense. Most health insurance policies charge you out-of-pocket fees throughout the year, known as deductibles and coinsurance (learn more in All the Ways You Pat: Premium, Co-Pays, and Coinsurance). Be sure to set some money aside so you won’t be caught off guard by these expenses.

6. Make Sure Your Doctor Is in Your Network

Health insurance plans have a list of approved providers. To see a doctor, that doctor needs to be on your plan’s list. If you like your doctor and don’t want to change, look for a plan that approves your doctor as a provider.

7. You Can Extend Your Work Coverage After Leaving a Job

When you leave a job, you’ll have to leave the company health insurance plan too. You don’t need to leave right away, though. You can stay on the company plan for up to 18 months after leaving a job because of a program known as COBRA. Your premiums might be more expensive, however, because your employer will no longer be helping you pay for your coverage.

8. Some Treatments and Medications Won’t Be Covered

Health insurance plans don’t cover every possible treatment and medication. They typically exclude new or experimental treatments that have yet to be proved. If you want these types of treatments, you’ll need to pay for them yourself.

9. Children Can Stay on Their Parents’ Plan as Adults

Children can stay on their parents’ health insurance plan as adults, but only until they turn 26.

10. Routine Dental and Vision Care Probably Won’t Be Covered

Most health insurance plans do not cover routine dental and vision care. If you have a medical problem that forces you to see an optometrist, that is likely to be covered but routine checkups are not. If you’re worried about these bills, you can buy a separate dental and vision insurance plan.

Your health is too important to leave to chance. Keep this information in mind so you can find the right coverage that will protect you and your loved ones.

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