U.S. Health Insurance Works

Medical costs in the United States can be very expensive. His single visit to the clinic can cost hundreds of dollars, and an average three-day hospital stay costs tens of thousands of dollars (or more), depending on the type of care provided. There are cases. Most of us cannot afford to pay such a large amount of money when we get sick. Especially because you never know when you’ll get sick or injured or how much care you’ll need. Health insurance offers a way to keep such costs down to a more reasonable amount. U.S. Health Insurance Works 






Insurance Gradient Decorative Accent

Normally, the consumer (you) pays an advance payment to the health insurance company. This payment allows you to share the ‘risk’ with many other people (candidates) who receive similar payments. Since most people are healthy most of the time, the dollars in premiums paid to insurance companies can be used to cover the costs of a (relatively) the small number of policyholders who become ill or injured. As you can imagine, insurance companies study risks extensively and their goal is to collect enough premiums to cover the insured’s medical expenses. There are so many different types of health insurance in the US with different rules and agreements regarding care.






Where can I get care?

One possibility for health insurance companies to control costs is to influence access to service providers. Providers include doctors, hospitals, laboratories, pharmacies, and other facilities. Many insurers contract with a specific network of providers who agree to offer their services at lower prices to their policyholders.

If the provider is not part of the plan’s network, the insurance company may not pay for the services provided or may pay a lower percentage of coverage on the network. This means that insured persons who are not connected to the network for care may have to pay a much higher percentage of costs. This is an important concept to understand, especially if you are not from the Stanford area.

For example, if you have a parental plan and the plan’s network is in your hometown, the care you need may not be available in the Stamford area or may be much more expensive to obtain. there is.






What does the plan include?

One of the things that happened with health care reform in the US (under the Affordable Care Act) was the introduction of standardization of insurance benefits. Prior to this standardization, the benefits offered varied significantly from plan to plan. For example, some plans covered prescriptions and others didn’t. Plans in the United States must now provide a number of “essential health benefits”, including:







Emergency Services

  • Hospitalization
  • Laboratory
  • Maternity and Newborn Care
  • Mental Health and Substance Abuse Treatment
  • Outpatient Services (out-of-hospital physicians and other services)
  • Pediatric Services, including Dental and Eye Care
  • Prescription Drugs
  • Preventive Services ( certain vaccinations) and treatment of chronic diseases
  • Rehabilitation Services





For international students who may be considering coverage by a plan based outside the United States, it is very important to ask the question, “What does the plan cover?”







How much will it cost

Understanding the cost of insurance coverage is actually very complicated. In our review, we talked about paying a premium to sign up for a plan. These are transparent upfront costs (so you know what you’re paying).




Unfortunately, for most plans, these are not the only costs associated with treatment. There are also usually costs associated with accessing care. These costs are recorded as deductibles, co-insurance, and/or co-payments (see definitions below) and represent what you pay out of your own pocket when you receive care. As a general rule of thumb, the more premiums you pay upfront, the less you will pay when care becomes available. The less you pay for insurance, the more you pay when care becomes available.




The question for the students is, do you pay now (large amount) or later (large amount)? In either case, we will pay for the care you receive. The approach is to pay a higher percentage of the upfront premium to minimize the costs incurred in fulfillment. The reason we consider it is that we don’t want barriers to care. We want our students to always have access to medical care.







Important Insurance Terms


The terms “deductible” and/or “co-payment” refer to the portion of the medical expenses that you are responsible for paying when you actually receive medical care. Monthly insurance premiums paid for long-term care are separate from these costs.







Annual Deductible:

The annual deductible is the amount you pay for each plan year before the insurance company starts paying a portion of your costs. If the deductible is $2,000, he will be responsible for paying his first $2,000 of medical expenses each year, after which the insurance company will start paying that portion.







Co-Payment (or “Co-Payment”):

Co-Payment is a fixed, up-front payment that you pay each time you receive care when the care is co-payable. For example, a doctor’s visit may cost him $30 out-of-pocket, after which his insurance company covers the rest. Plans without co-payments typically use other cost-sharing methods.








The deductible is a percentage of your medical expenses. For an MRI that costs $1,000, you may pay 20% ($200). The insurance company pays the remaining 80% ($800). Higher premium plans usually have less coinsurance. U.S. Health Insurance Works 







Annual Deductible:

The Annual Deductible is the maximum out-of-pocket amount you will pay in one year. This is the sum of deductibles, copayments, and coinsurance (excluding premiums). Once that cap is reached, the insurance company will pay him 100% of the covered costs for the remainder of the plan. Most enrollees never reach their deductible limit, but it can happen when they need expensive medical treatment due to a serious accident or illness. In general, the higher the premium of his plan, the more the deductible limit amount is lower. U.S. Health Insurance Works 







Meaning of ‘Indemnification Benefit’:

The terms ‘Indemnification Benefit’ and ‘Coverable’ are used regularly in the insurance industry and can be confusing. “Covered Benefits” generally refer to medical services that are included in (that is, “covered”) the premium of a particular health plan paid by or on behalf of an enrolled patient. “Covered” means that a portion of the reimbursable cost of medical services is covered by the insurance company. This does not mean that you will be paid 100% for the Service. U.S. Health Insurance Works 

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