Insurance FAQ

Answers to your most common health insurance questions.

General Insurance Questions

Basic concepts and information about health insurance

What is health insurance and why do I need it?

Health insurance is a contract between you and an insurance company that helps pay for medical expenses when you need care. Without health insurance, you'd be responsible for paying the full cost of medical services, which can be extremely expensive.

Health insurance provides financial protection against unexpected medical costs, helps you access preventive care to stay healthy, and can give you peace of mind knowing you're covered if you get sick or injured. It's an essential part of your financial security and overall wellbeing.

What's the difference between HMO, PPO, EPO, and POS plans?

These acronyms refer to different types of health insurance plans, each with its own structure for provider networks and rules for coverage:

  • HMO (Health Maintenance Organization): Typically requires you to choose a primary care physician (PCP) who coordinates your care and provides referrals to specialists. You generally must stay within the plan's network of providers for coverage, except in emergencies.
  • PPO (Preferred Provider Organization): Offers more flexibility, allowing you to see any healthcare provider without a referral, though you'll pay less if you use providers in the plan's network. PPOs typically have higher premiums but lower out-of-pocket costs than HMOs.
  • EPO (Exclusive Provider Organization): A hybrid that combines features of HMOs and PPOs. Like an HMO, you must use providers within the network (except in emergencies), but like a PPO, you typically don't need referrals to see specialists.
  • POS (Point of Service): Another hybrid plan where you choose a PCP who provides referrals, but you have the option to go out-of-network (at a higher cost) if you choose.

The best plan type depends on your healthcare needs, budget, and preferences regarding provider choice and cost structure.

What is the Affordable Care Act (ACA) and how does it affect me?

The Affordable Care Act (ACA), also known as Obamacare, is a comprehensive healthcare reform law enacted in 2010. Key provisions that may affect you include:

  • Insurance companies cannot deny coverage or charge more based on pre-existing conditions
  • Young adults can stay on their parents' health insurance until age 26
  • Preventive services (like annual check-ups, vaccinations, and screenings) must be covered at no additional cost
  • Health plans must cover essential health benefits, including prescription drugs, maternity care, and mental health services
  • Income-based subsidies are available to help make insurance more affordable for those who qualify

The ACA also established Health Insurance Marketplaces where individuals and small businesses can compare and purchase health insurance plans.

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