Health Insurance 101
To international students and scholars visiting the United States, the US health care system might seem impossibly complicated and confusing. This is because the US health care system is impossibly complicated and confusing; most US citizens don't even fully understand it. The following is a short guide to help you to better understand the US health care system, so you will be fully prepared for your stay in the United States.
What is health insurance?
The term refers to a variety of insurance policies, ranging from those that cover the costs of doctors and hospitals to those that meet a specific need—like vision or dental coverage. When most of us talk about health insurance, however, we refer to the kind of plan that covers doctor bills, surgery and hospital costs. Just like car or home insurance, you pick a health insurance plan and agree to pay a specific rate, or premium, for that policy. In return, the insurance company agrees to pay a specific percentage of your medical expenses for a specific list of medical services (covered services).
How does health insurance work?
In return for your premium, the insurance company agrees to share the cost of covered medical services with you. Those services are listed in your policy along with your out of pocket cost for each service—copay, a deductible or coinsurance. Not all medical services are covered by health insurance plans; the ones that aren’t are called exclusions and limitations and they are listed in the policy brochure.
Types of health insurance
Health insurance is an umbrella term; there are different kinds of health insurance products to cover different kinds of healthcare needs. Medical health insurance benefits may include preventive care and benefits for illnesses and accidents, either in or out of the hospital. For other healthcare needs, you may need other types of insurance like: Dental insurance: covers your oral health and usually includes regular cleanings and things like cavities. Vision insurance: covers your eyes’ health and can include coverage for glasses or contacts.
Who’s in and who’s out
Most insurance companies have negotiated discounts with doctors and facilities. Payments by your insurance company are usually based on these discounted rates and those doctors and facilities are called in network. Because it saves the insurance company (and you, the insured!) money, you are rewarded for seeking care in network or with preferred providers with a lower out of pocket cost and lower overall cost of care. On the flip side, if you choose to use an out of network doctor or facility, you’re still covered, but the copay, coinsurance, deductible and other benefits may be different than when staying in network. Be sure to read that policy carefully so you know what to expect!