What Is Insurance and Why Is It So Important?

Published on
October 19, 2023
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No one adds “get pneumonia” or “ankle sprain” to their calendar. As much as we hope to never need to visit urgent care, most of us do need medical care at some point or another. Preventative care can also catch small health problems before they snowball into big ones. If you don’t have health coverage, you’re stuck paying the entire bill in full. Considering just getting an X-ray can cost up to $400, going without insurance is a major risk. Aside from being protected from crushing medical expenses, having health insurance makes taking care of your physical and mental health much more accessible.

Not sure where to start? Let’s review the health insurance basics

Health insurance can be confusing, but it’s not as complicated as it seems. When you sign up for a health insurance plan, you’ll have several coverage options to pick from depending on your needs and budget. Factors to consider when choosing a plan include:

Health Insurance Tiers: Health plans are typically arranged in tiers. Gold or platinum plans offer the most comprehensive coverage, while bronze offers the least. All plans cover an annual physical and emergency medical treatment, but you’ll have to pay more out of pocket if you have a lower-tier plan.  

HMOs vs PPOs: In addition to tiers, health insurance plans are broken into two categories: HMOs or PPOs. HMOs usually cost less per month, but members are required to visit care providers within a certain network. A PPO is more expensive per month, but members can use providers both in and out of network without getting a referral. If you see specialists frequently, the flexibility of a PPO may be worth the higher premium.

Monthly Premiums: Every insurance plan comes with a monthly premium. Higher-tier plans and PPOs typically have higher premiums.

Deductibles: In addition to a monthly premium, health insurance plans require members to pay a certain amount before their coverage kicks in. This is called a deductible. If a plan has a $1,500 deductible, that’s how much you’ll need to pay yourself before your insurance begins to pay. This doesn’t include services that are included in the plan for free, like an annual wellness exam, preventative screenings, and vaccines.

Copayments: After you’ve met your plan’s deductible, you’ll still need to pay copayments when you receive medical services. Copayments can be a flat fee or a percentage of the cost of care. For example, your plan may require a $25 copayment for every doctor’s visit outside of your annual wellness exam, or $50 for every visit to the ER. Some services, like diagnostic tests, might require you to pay a percentage of the cost yourself. If you have a 20% copay, your insurance will pay 80%, and you’ll have to pay the remaining 20% yourself.

Statistically, having a health insurance plan improves your quality of life– And your family’s too!

The most obvious benefit of having health insurance is that you’re protected from unexpected, high medical costs. Considering the average cost of hospital care after a heart attack is over $50,000, and a C-section costs over $20,000, that benefit alone justifies the expense. Members also pay less for covered, in-network care, even if they haven’t yet met their deductible. If you have kids, all the preventative care they need is covered, and so is yours.

In short, health insurance makes healthcare more accessible. When people aren’t stuck worrying about whether they can afford an ambulance ride or not, they’re more likely to get the medical attention they really need. Those with health insurance have lower death rates and better health outcomes in the long run. They also are more likely to take prescribed medication consistently when cost is no longer a barrier.

Because physical and mental health impact every facet of our lives, having health insurance improves well-being throughout the entire community. People who can access health care easily are more likely to prioritize their health and address medical issues, increasing productivity and improving financial wellness. Coverage also makes it easy to get preventative care, lowering the number of visits to the emergency department later on.

What happens if you’re not insured?

If you’re not insured, cross your fingers and hope you never get sick. A trip to the ER can easily cost thousands. It’s possible to set aside money in a Health Savings Account, or HSA, but should not be considered a replacement for health insurance coverage. An HSA can be a valuable part of a comprehensive healthcare strategy to help cover your plan's deductible and copays, and it comes with beneficial tax advantages. Nevertheless, without insurance, you’ll be stuck paying full price for every service, which can easily exceed what most of us can reasonably save. In other words, going uninsured is a huge gamble that’s rarely worth the risk.

If you have any pre-existing conditions, don’t worry. The Affordable Care Act stipulates that health insurance companies can’t charge extra or refuse coverage just because someone has an existing health condition.

Okay, I’m sold. When can I sign up?

Every year, there’s an opportunity to sign up for a new insurance plan or change your old one. The enrollment period is called open enrollment, and it runs from November 1st, 2023 through January 15th, 2024. Some states offer extended enrollment through January 30th.

Outside of that window, you can only sign up for insurance if you have a qualifying life event, like losing health coverage through your employer or getting married. Short-term insurance plans are available if you miss the deadline, but they’re expensive and are designed for temporary coverage gaps. It’s much easier to plan ahead and sign up for the right policy during open enrollment.

Find the coverage option that’s right for you

With open enrollment around the corner, this is the ideal time to start planning your next health insurance move. Follow HealthBird on social to get real-time updates, or get free quotes for health plans, dental, vision, and more in minutes.

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