How U.S. Health Insurance Works - PlantSolo

In the United States, medical expenses can be extremely costly. A single visit to the doctor could cost several hundred dollars, depending on the type of care received; a typical three-day hospital stay could cost tens of thousands or more. Most of us wouldn't be able to afford such high costs if we got sick because we never know when we might get ill or hurt or how much care we might need. Health insurance can help reduce these costs to more tolerable levels.

The consumer (you) typically pays an upfront premium to the health insurance company, which enables you to share the "risk" with numerous other enrollees who are also paying a comparable amount. Since most people lead generally healthy lives, the insurance company can use the money it collects in premiums to cover the costs of the (relatively) small number of enrollees who get sick or are hurt. Insurance companies have conducted much research on risk, as one might expect, and their goal is to collect enough premiums to cover the enrollees' medical costs. There are many different types of health insurance plans in the United States, along with many other laws and healthcare policies.

 

The three essential questions listed below should be considered when selecting the best health insurance.

Q1. Where can I get medical care?

One strategy health insurance plans use to cut costs is influencing provider access. Physicians, hospitals, laboratories, pharmacies, and other businesses are a few examples of providers. Numerous insurance companies have contracts with a specific network of providers who have consented to charge plan participants less for their services.

 

Suppose a provider is not in a plan's network. In that case, the insurance company may only pay for the service(s) provided, or it may pay less than it would for care from providers who are. This suggests that the enrollee seeking care outside the network may have a significantly larger cost-sharing obligation. Understanding this concept is essential, especially if you're originally from somewhere other than the Stanford area.

If your network is in your hometown and you have a plan through your parents, for example, you might not be able to get the care you need in the Stanford area, or you might have to pay a lot more.

Q2. What does the plan cover?

One of the achievements of the U.S. healthcare reform brought about by the Affordable Care Act is the increased standardization of insurance plan benefits. Before this standardization, the benefits offered by different plans differed significantly. For example, some plans covered prescription drugs, while others did not. In the U.S., projects now have to provide several "essential health benefits," like

• Emergency assistance

• Hospitalization

• In-lab examinations

• Newborn and maternity care

• Treatment for substance abuse and mental illness

• (Medicals and additional services obtained outside of a hospital) ambulatory care

• Services for children, such as dental and eye care

• Drugs on prescription

• Preventive services, such as some immunizations and chronic disease management

• Therapeutic services

In particular, our international student population may be considering purchasing insurance through a non-U.S.-based plan; therefore, it is essential to ask, "What does the plan cover?"

Q3. How much will it cost?

Insurance costs are challenging to comprehend. Our overview mentioned a premium when signing up for a plan. You are made aware of this expense upfront.

 

Regretfully, most plans incur additional costs for the care you receive. Usually, you have to pay for this medical care. These expenses are known as copays, deductibles, and coinsurance (see the definitions below), and they represent the part of the treatment cost you are responsible for covering out of pocket. You will generally pay less when you access to care if you pay higher upfront premiums. You will have to pay fewer dividends the more you spend on medical care.

Our students must choose between paying now or later (a more significant portion). The cost of the care you receive will be your responsibility. Spending a more substantial portion of the upfront premium is better to minimize the expenses incurred during service. We concluded that to prevent students from accessing care, we want to remove barriers, such as a high copay at the time of service. We want students to have access to healthcare when needed.