Health Insurance: How It Protects You From Most Health and Financial Risks

Does your employer provide health insurance coverage? If not, you can get your personal coverage covering essential health benefits. The main benefit of getting marketplace health insurance is that it protects you from paying enormous high costs out of pocket in emergencies. Here’s a deeper look at what marketplace health insurance provides.

Essential Features of Marketplace Health Insurance

  • Ambulatory patient services – Includes outpatient care
  • Birth control coverage – Includes various forms of contraceptives
  • Dental coverage – Insurers consider dental coverage essential for children but not for adults
  • Emergency services – Get emergency help from the nearest hospital, even if it’s outside your plan’s network
  • Hospitalization – Includes surgery and a hospital bed for several days
  • Pregnancy, maternity, and infant care – Throughout pregnancy and after birth
  • Care for mental health and substance use disorder – Encompasses counseling, behavioral health treatment, and psychotherapy
  • Prescription drugs – Get discounts on drugs prescribed by your doctor
  • Rehabilitative services – Includes medical devices to help patients overcome injuries
  • Laboratory services – Get lab tests to help the doctor diagnose your condition
  • Preventive and wellness services – Includes management of chronic diseases
  • Pediatric services – Includes oral and vision care

Marketplace Plans Help You Access Essential Health Benefits

When you secure a marketplace health insurance plan, you’ll pay much less than you would without a plan, and you’ll still need to pay a deductible. The qualifying types of marketplace plans include EPO, HMO, and PPO. Here’s a quick breakdown of these three plans:

  • Exclusive Provider Organization (EPO) – Other than emergencies, this type of plan requires you to use doctors and other medical professionals or hospitals associated with your plan’s network.
  • Health Maintenance Organization (HMO) – This plan, which includes prevention and wellness services, usually only provides coverage from doctors who sign a contract with the HMO. It’s typically for patients who live or work within the plan’s service area.
  • Preferred Provider Organization (PPO) – WIth this coverage, you have the option to pay less if you stay within the plan’s network. You can still choose your doctor or hospital even if it’s outside the plan’s network.

Preventive services are divided into three categories to facilitate adults, women, and children. Some of these services may be free, depending on the plan, and usually require staying within the plan’s network of doctors and hospitals. Certain preventive services do not require copayment or coinsurance charges.

Adults can get free counseling and screening for blood pressure and a long list of conditions, including diabetes and hepatitis B or C. It also includes immunizations for various diseases, including influenza, measles, and rubella. Pregnant women can get free preventive services related to breastfeeding support, maternal depression, and other pregnancy concerns. Free preventive care for children covers many of the same screenings for adults. Make sure you and your family members are covered with sufficient health insurance. You never know when you may need to see a doctor for an emergency. Contact our team at ISU Wissink Agency to talk with our insurance experts and learn your options for CA health insurance coverage today!