3 Common Misconceptions about Health Insurance

While it may not be glitzy or exciting, health care coverage is a fundamental topic of adulting.

Man sits at desk looking over health plan information.;

Some conversation topics are easy: How’s the weather? What’s your favorite ice cream flavor? Others, when brought up in a social setting, may cause you to hit the metaphorical snooze button. For many, health insurance is one of these topics.

Tackle a few of the most common misconceptions and you’ll be on your way to understanding how to make smart choices about health insurance.

Misconception #1: If I don’t go to the doctor regularly, it’s not worth having a health plan.

At a minimum, health insurance should provide peace of mind that if you fall ill or get in an accident, you won’t go bankrupt trying to cover medical costs.

But modern health insurers provide many benefits that go beyond the basics. For example, most plans cover preventive services that can help you stay healthy or detect problems early, when they are more treatable. These services—often covered 100%—include immunizations, cancer screenings, and annual physicals. Many also offer discount programs for services like acupuncture, LASIK, and gym memberships.

Related: Stay Healthy with Preventive Care

It’s also useful to know that your health insurer negotiates discounted rates with providers, so you’re protected from paying whatever a doctor deems appropriate. When you use a doctor in your health plan’s network, you won’t be asked to pay anything beyond these “allowed amounts” for services covered by your plan.

Misconception #2: If I’m paying the insurance company for a premium, I should also pay them for any bills I receive.

This one can be confusing. Your premium is the monthly bill you pay for insurance coverage—to be a member of your health plan.

After you visit the doctor, she sends your health insurance company a claim. The health insurer processes that claim and sends you an Explanation of Benefits (known as an EOB), which explains what was billed and how much you are responsible to pay. An electronic version of this document is also sent to your doctor, along with a check for any applicable payment.

Once everyone has figured out who owes what, it’s your turn to pay your doctor for any services that has provided—this is a good time to refer to that EOB and make sure the bill you received is for the right amount. If you’re confused, don’t be afraid of asking for help. If you’ve got a question, your health insurer has probably heard it before!

Misconception #3: I can’t afford an insurance plan. Period.

This may be true—or it may not. Affordable Care Act plans, or those sold on the government marketplace, are still available, and you may be surprised at the options. Before you purchase a plan this year, it’s worth your time to find out whether you qualify for a subsidy or cost-sharing reduction. You may be able to reduce your overall premium cost. This year’s open enrollment for individual and family plans starts November 1 and ends December 15, 2021.

There’s no doubt that insurance can be confusing. When you have questions, don’t give up or feel stuck. Call your health insurance company and ask them to help you understand—a good health plan is happy to walk you through the basics of coverage or the nitty-gritty details of a claim. Put them to the test, and you’ll know if their service is up-to-snuff before you settle for a plan.

Related: Tips to Help You Prepare for Open Enrollment

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