{"id":352585,"date":"2017-05-31T16:02:43","date_gmt":"2017-05-31T21:02:43","guid":{"rendered":"https:\/\/content.findlaw-admin.com\/ability-law\/consumer\/insurance\/health-insurance.html"},"modified":"2024-01-24T14:30:09","modified_gmt":"2024-01-24T19:30:09","slug":"health-insurance","status":"publish","type":"page","link":"https:\/\/www.findlaw.com\/consumer\/insurance\/health-insurance.html","title":{"rendered":"Health Insurance"},"content":{"rendered":"\n
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Health Insurance<\/h1>\n
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\n By Oni Harton, J.D.<\/a> | Legally reviewed by Melissa Bender, Esq.<\/a>\n | Last updated\n
\n \n <\/i>\n Legally Reviewed\n <\/summary>\n\n
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This article has been written and reviewed for legal accuracy, clarity, and style by FindLaw\u2019s team of legal writers and attorneys<\/a> and in accordance with our editorial standards<\/a>.<\/em><\/p>\n\n <\/div>\n <\/details>\n\n

\n \n <\/i>\n Fact-Checked\n <\/summary>\n\n
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The last updated date refers to the last time this article was reviewed by FindLaw or one of our contributing authors<\/a>. We make every effort to keep our articles updated. For information regarding a specific legal issue affecting you, please contact an attorney in your area<\/a>.<\/em><\/p>\n\n <\/div>\n <\/details>\n<\/section>\n

Nothing compares to good preventative care when it comes to protecting your health. In this regard, health insurance is critical in safeguarding and addressing health expenses for most people.<\/p>\r\n

Health insurance affects everyone, regardless of your health insurance coverage status. Maybe you don’t have health coverage<\/a> but wish you did after experiencing an unexpected illness or accident. You may have a health insurance plan but don’t know your coverage options.<\/p>\r\n

It’s important to recognize that healthcare benefits and laws are ever-changing. This impacts your health insurance options. The article below discusses some of health insurance’s more critical legal aspects.<\/p>\r\n

How Health Insurance Works<\/h2>\r\n

You pay the deductible if you receive healthcare services for covered medical expenses<\/a>. The insurance company then pays for specific percentages of different types of medical care. Payments are subject to policy limits, exclusions, and copays.<\/p>\r\n

If you receive healthcare services for covered medical expenses, you first pay the deductible. The insurance company then pays for certain percentages of different types of medical care.<\/p>\r\n

For example, the insurer may cover 80% of medically necessary surgical operations. You would then pay the other 20% until you reach your out-of-pocket maximum.<\/p>\r\n

Policyholder wellness is vital to the health insurance company. The insurance company hopes to insure as many healthy people as possible. Insuring healthy people means reductions in costs, as healthy people will likely use the policy less than policyholders with health issues will.<\/p>\r\n

Premiums from healthy people help cover the costs of those who are less healthy. Government-sponsored health insurance programs represent an important segment of the insurance market. Medicare and Medicaid<\/a> are federal programs. Medicare provides insurance to people over 65. Medicaid provides health insurance to low-income individuals.<\/p>\r\n

Open Enrollment Period<\/h2>\r\n

It’s critical to be aware of applicable deadlines. Health insurance coverage comes with an open enrollment period. This is the case whether your coverage is through your employer, Medicare, or the Affordable Care Act<\/a> (ACA) marketplace.<\/p>\r\n

The ACA<\/h3>\r\n

For ACA plans, some state-based marketplaces may have open enrollment periods<\/a>. These timelines may differ from federal-based marketplaces. That’s something to keep in mind.<\/p>\r\n

Private Employers<\/h3>\r\n

Your place of employment determines the open enrollment period for your plan. Employers often have open enrollment in the fall. This timeline allows selected benefits to start at the beginning of the calendar year.<\/p>\r\n

Medicare Plans<\/h3>\r\n

For Medicare plans, there are Medicare enrollment periods. A Medicare Advantage Plan<\/a> allows you to join, switch, or drop plans during enrollment. The open enrollment period also allows you to add or drop prescription drug coverage.<\/p>\r\n

Special Enrollment Periods<\/h2>\r\n

There are exceptions to the open enrollment period for health insurance plans. You may qualify to enroll during special enrollment periods. For example, you can only enroll or change health insurance marketplace plans if you experience certain life events. Special life events for marketplace plans can include:<\/p>\r\n