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Medical care can be expensive. Health insurance helps manage these costs, possibly helping you receive necessary care without significant out-of-pocket expenses.
Most policies cover doctor visits, hospitalizations, emergency care, prescription drugs, and preventive care. However, exact coverages can vary.
The premium is the amount you pay for the insurance policy. The deductible is what you pay out of pocket before insurance begins covering. Copayments are fixed amounts you pay for services (e.g., a doctor visit), and coinsurance is a percentage of costs you cover after meeting the deductible.
In-network providers have agreements with the insurance company for specific rates. Out-of-network providers don't have such agreements, which can result in higher out-of-pocket costs.
Under the Affordable Care Act in the U.S., insurance companies are prohibited from refusing coverage or charging higher premiums due to pre-existing conditions. This rule extends to various conditions, ensuring that individuals have access to necessary coverage regardless of their health status.
Many policies cover mental health services, but coverage can vary. The ACA requires most plans to cover mental health and substance use disorder services.