Health care is an intricate network that includes providers, patients, payers, research trials, organizations and institutions as well as related businesses governed by laws, regulations and policies.
No matter whether you are an individual or employer, finding the appropriate health care plan for your needs is of utmost importance. Avoid plans which do not include your preferred doctors or have limited number of providers within their network.
Costs
Cost is often an overwhelming barrier to health care for those in need, yet financial assistance programs make it possible for many individuals and families to afford this essential care.
The Affordable Care Act (ACA) offers tax credits and cost sharing reductions to individuals who purchase private health insurance policies themselves, while many cities and states run financial assistance applications to assist residents access Medicare, Medicaid, the Children’s Health Insurance Program (CHIP), as well as tax credits for low-income families.
The Center for American Progress estimates that health care payers and providers spend twice the necessary amounts on billing- and insurance-related costs. Reforms designed to eliminate unnecessary expenditure could save billions annually.
Coverage
Health care coverage gives individuals access to a variety of medical services that help keep them healthy while saving them money.
Coverage for medical care costs is provided through both private and public entities, such as employer-sponsored health plans, Medicare, Medicaid, VA programs or similar initiatives. Each program has their own rules and regulations that help keep costs reasonable for participants.
Your provider network depends on the type of health plan you have; this could include doctors, hospitals and pharmacies who have accepted discounts from insurers for their services. Certain plans limit or mandate using providers within their network only for medical care needs.
When visiting an out-of-network provider, your share of costs will likely increase as compared to using one in your network. Your insurance plan should outline your out-of-pocket costs per service including copays, deductibles, or co-insurance percentages.
