How Health Insurance Works

There are few things in life as confusing as a health insurance policy.  But, when you break it down into simplified terms it can make finding a health insurance policy in Boston and other locations a lot easier. Health insurance is designed to protect you from high or unexpected health bills and this coverage is provided to individuals because they pay premiums for this coverage.

Your health insurance policy in Boston or wherever you live is a contract between you and the insurance company.  The contract is renewable on a yearly or monthly basis.  The type of coverage that you receive is based on the type and amount of health care coverage you receive is laid out in this plan.  There are several components to health insurance that you must understand in order to understand your policy.

Your premium is the amount that the policy-holder pays each month to purchase the plan. The individual usually has this money automatically withdrawn from their check, but in the case where you are self-employed you will pay this amount directly to the insurance company.

The deductible is the amount that you, as the policy-holder, must pay out-of-pocket before the health plan will pay its share of the expense.  If you have a $1,000 deductible then you must pay that amount towards your bill out of your own pocket.  The insurance company then pays the remainder of the amount.  Each amount time you go to the doctor or get a prescription you must pay for it until you reach your deductible, once the deductible is met the insurance company will then begin covering your healthcare expenses.  

Exclusions are the services that are not covered.  These are healthcare services that the policy-holder must pay on his or her own.  These types of services usually include surgeries that are not considered to be vital to your life, such as cosmetic surgery.

Out-of-pocket maximums are sort of like coverage limits.  The policy holder's obligation to pay ends when they reach the out-of-pocket maximum and the health plan will cover the additional costs.  These maximums can be limited to certain areas of your policy, such as prescription costs and they may apply to all of the coverage that is provided during the benefit year.

Health insurance companies often have a network of providers that will accept the fees that are set by the insurance company.  This is designed so that the patient is able to use an "In-network" provider and receives a lower cost on services.  Some health care providers simply bill the insurance company as long as the policy-holder agrees to pay the remainder that is not covered.  

When you break down health insurance in Boston to its simpler terms, it makes it much easier for you to make sense out of a confusing health insurance policy. When Tom Jones broke down his Boston health insurance down into its main points, he found that he would actually save money on a particular plan and receive additional benefits that other plans did not offer.

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