Health Insurance

Ever see a medical bill in full?

Take a look.

See that number there? $1788.22? From the looks of it, that's for an ambulance ride and maybe one night in the hospital. Imagine if you had to stay multiple nights? Or if you had a chronic illness that meant weekly visits and costly meds? Yeah, staying healthy is expensive. Sometimes like millions of dollars expensive.

How Does Health Insurance Work?

Health insurance works the same way as car insurance: you pay a monthly premium, and then if something happens, the insurance company will pay for some or all of your bills.

Health insurance can cover all matters of things:

  • Regular visits to the doctor
  • Specialized visits (like to a dermatologist or optometrist)
  • Ambulance rides
  • Emergency room visits
  • Medication
  • Specialized treatments
  • Hospital stays

But, of course, it depends on your policy. If you pay a high premium, you'll get a lot of these benefits; if you pay a lower one, you'll probably get less. Here are a few other factors that might affect the price of your insurance.

Deductible. You can take a look at our definition, but the basic idea is that you will have to pay up to a certain amount no matter what. So if you get a bill for $486 from your doctor and your deductible is $300, you'll owe $300, and your insurance company will cover the remaining $186. Higher deductibles = lower premiums, and vice versa.

Co-pay. Sometimes when you go to the doctor or pick up medication, you'll pay some small amount: say, $20 or $50. (Small compared to what the actual visit costs—doctors are expensive.) That's your co-pay; the insurance company covers the rest. Higher co-pays = lower premiums, and vice versa.

Percent covered. Sometimes insurance policies will cover 100% of one thing and only 50% of another. Be sure to keep your eye out for that; if the thing they cover only 50% of is something that happens to you often, you'll likely end up paying a lot out of pocket. Take a look at this chart for an example of what co-pays and percentages can look like.

Out-of-pocket maximum. Most insurance policies include an out-of-pocket maximum: that's the maximum amount you'll have to pay in any given year. So let's say you've had a really nasty year and have racked up so much in medical bills that you've paid $6,000 between deductibles, co-pays, and other costs; let's also say that your out-of-pocket maximum is $6,000. That means that the next thing that happens to you within that year will cost you nothing—no matter what your deductible or co-pay normally is.

Except…

Network. If you're in-network—meaning you go to a doctor that takes your insurance—all those rules apply. But if you go out-of-network, that's all off the table. So if something happens to you and you're taken to an emergency room that's out of network…you might be looking at some serious debt. Want a real-life example? Read it and weep—literally.

Finding Health Insurance

You probably have a few options for health insurance:

  • Your parents' health coverage. If your parents have health insurance, you can hop on that train until you're 26. Not too shabby.
  • Social welfare programs. If you can't afford health insurance, programs like Medicaid or the State Children's Health Insurance Program can help you out.
  • Your job. Most Americans get their health insurance through their employer. It's usually the cheapest option because your boss will usually pay for some of your insurance costs; and, since there's a big group of people (everyone you work with) going in on it, your overall costs are lower.
  • Stop-gap health insurance. Let's say you leave one job for another—but there's a month in between. What happens? The Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) lets you stay on your current health insurance for a certain amount of time until you're able to switch over. Student and short-term health insurance can cover similar issues.
  • Individual health care. If you're an adult and don't get health insurance from your job, you might have to buy health insurance directly from insurance companies. It'll cost more—especially if you're not super healthy—but you definitely need it. The law agrees.