Health Insurance and the Health Insurance Marketplace
The Value of Health Insurance
No one plans to get sick or hurt, but most people will need medical care at some point. To continue our mission to be good help to those in need, Bon Secours St. Francis Health System wants to make sure you have health insurance that not only fits your budget, but also meets your needs. We are here to help guide you to the best health insurance for you and your family.
Health coverage helps pay costs when you need care.
Health coverage helps pay for your medical care costs and protects you from very high expenses.
Did you know the average cost of a 3-day hospital stay is $30,000? Or that fixing a broken leg can cost up to $7,500? Having health coverage can help protect you from high, unexpected costs like these.
Your insurance policy or summary of benefits and coverage will show what types of care, treatments and services are covered, including how much the insurance company will pay for different treatments in different situations.
What is health insurance?
Health insurance is a contract between you and your insurance company. You buy a plan, and the company agrees to pay part of your medical costs when you get sick or hurt.
There are other important benefits of health insurance. Plans can provide free preventive care, like vaccines and check-ups. They also cover some costs for prescription drugs.
What do you pay for health insurance?
You’ll usually pay a premium every month for health coverage, and you may also have to meet a deductible once each year before the insurance company starts to pay its share.
How much you pay for your premium and deductible is based on the type of coverage you have.
Just as important as the premium cost is how much you have to pay when you get services.
• How much you pay for care before your insurance company starts to pay its share (a deductible)
• What you pay out-of-pocket for services after you pay the deductible (coinsurance or copayments)
• How much in total you’ll have to pay if you get sick (the out-of-pocket maximum)
What your policy covers is often directly related to how expensive the health insurance policy is. The policy with the cheapest premium may not cover many services and treatments.
5 things to know about health insurance
- There are many kinds of private health insurance policies. Different kinds of policies can offer very different kinds of benefits, and some can limit which doctors, hospitals, or other providers you can use.
- You may have to pay coinsurance or a copayment as your share of the cost when you get a medical service, like a doctor’s visit, hospital outpatient visit, or a prescription. Coinsurance is usually a percentage amount (for example, 20% of the total cost). A copayment is usually a fixed amount (for example, you might pay $10 or $20 for a prescription or doctor’s visit).
- You may have to pay a deductible each plan year before your insurance company starts to pay for care you get. For example, let’s say you have a $200 deductible. You go to the emergency room and the total cost is $1,250. You pay the first $200 to cover the deductible, and then your insurance starts to pay its share.
- Health insurance plans contract with networks of hospitals, doctors, pharmacies, and health care providers to take care of people in the plan. Depending on the type of policy you buy, your plan may only pay for your care when you get it from a provider in the plan’s network, or you may have to pay a bigger share of the bill.
- You may see products that look and sound like health insurance, but don’t give you the same protection as full health insurance. Some examples are policies that only cover certain diseases, policies that only cover you if you’re hurt in an accident, or plans that offer you discounts on health services. Don’t mistake insurance-like products for full comprehensive insurance protection.
About Health Insurance Marketplace
Better health insurance choices
The Marketplace is a new way to find health coverage that fits your budget and meets your needs. With one application, you can see all your options and enroll.
Every health insurance plan in the new Marketplace will offer essential health benefits, including doctor visits, preventive care, hospitalization, prescriptions, and more. You can compare plans based on price, benefits, quality, and other features important to you before you make a choice.
Insurance plans run by private companies
Insurance plans in the Marketplace are offered by private companies, and they cover the same core set of essential health benefits. No matter where you live, you’ll be able to compare your health insurance options in the Marketplace and find a health plan that meets your needs and fits your budget.
There will also be new protections for you and your family. Health insurance companies can’t deny you coverage or charge you more due to pre-existing health conditions, and they can’t charge women and men different premiums.
Explore the Marketplace now
Visit HealthCare.gov now to get answers to your questions and sign up for e-mail or text updates about the Marketplace. You can also call the Health Insurance Marketplace Call Center at 1-800-318-2596. TTY users should call 1-855-889-4325.
When open enrollment begins, you can go to the Marketplace and apply for health coverage, compare all your options, and enroll in a plan in one application.
Open enrollment starts October 1, 2013. Coverage starts as soon as January 1, 2014.
3 things to know about the Health Insurance Marketplace
- It’s an easier way to shop for health insurance. The Marketplace simplifies your search for health coverage by gathering the options available in your area in one place. With one application, you can compare plans, and explore any free or low-cost programs you may qualify for.
- Most people can get a break on costs. When you use the Health Insurance Marketplace you may be able to get lower costs on your monthly premiums and out-of-pocket costs. When you fill out your Health Insurance Marketplace application, you’ll find out how much you can save. Most people who apply will qualify for some kind of savings.
- Gives you control over your options with clear, apples-to-apples comparisons. In the Marketplace, information about prices and benefits is written in simple language. You get a clear picture of what premiums you’d pay and what benefits and protections you’d get before you enroll. Compare plans based on what’s important to you, and choose the combination of price and coverage that fits your needs and budget.
Affordable Care Act Resources
NEW HORIZON FAMILY HEALTH SERVICES, INC.
BLUE RETAIL CENTER
Customer Service Representatives
BON SECOURS HEALTH SYSTEM
Customer Service 800-805-5678
For more information on the Health Insurance Marketplace or to enroll www.healthcare.gov