You may be wondering how buying health insurance really helps you. It can cost a lot and, if you’re healthy, rarely used. While the Affordable Care Act provides greater access to health insurance, it also mandates that all plans offered on the Marketplace include the same essential health benefits and preventive services. These services will be important if you have unexpected medical needs or just want to make sure you stay healthy.
No matter what plan you purchase, you are guaranteed to have essential health benefits including coverage for: ambulatory patient services, emergency services, hospitalization, maternity and newborn care, mental health and substance abuse disorders, including behavioral health treatment, prescription drugs, rehabilitative and habilitative services and devices, laboratory services, preventive and wellness services, and chronic disease management, pediatric services, including oral and vision care.
Plans sold on the Marketplace will also include preventive services you can receive with no cost-sharing involved. So things like breast and colon cancer screenings, screening for diabetes, blood pressure and high cholesterol, and routine vaccinations will all be provided without the patient having to pay a copay, deductible or coinsurance as long as the primary purpose of the visit was for the recommended preventive service.
The benefits don’t stop there. As of Jan. 1, 2014, health insurers must sell health coverage to anyone who applies, regardless of that person’s medical history or health status. This is often referred to as guaranteed issue. In addition, insurers will not charge higher premiums for those who have been or are sick, including those with pre-existing conditions. Premiums will be based solely on a person’s age, location, family size and whether or not they use tobacco products.
So, why is there all this fuss about health insurance? Here are a few things to keep in mind: Having health insurance will improve your access to health care and protect your financial well-being.
Health insurance was created to cover the costs of hospital stays; now, it covers everything from major illnesses to everyday medical expenses. In addition, having health insurance increases your opportunity to receive preventive care and treatment for chronic conditions before the conditions become too serious.
Health insurance allows you and other Kansans to develop a relationship with a primary care doctor rather than seeking treatment for basic care in an emergency room. Doctors, hospitals and other health care providers prefer patients with health insurance because they know the insurance company will pay the valid claims quickly.
Finally, it provides financial security by protecting you from large bills. Having health insurance limits the amount you pay for specific out-of-pockets costs such as deductibles, copays or coinsurance amounts. These amounts may still seem like a lot of money, but the Affordable Care Act includes assistance to help some people pay for these out-of-pocket costs.
Remember, health care is expensive. Routine care, such as a doctor's office visit for a physical, might be manageable, but care for chronic conditions like diabetes or diseases like cancer can costs thousands of dollars a year.