How U.S. Health Insurance Works

In the US, medical treatment can be exceedingly costly. A typical three-day hospital stay can cost tens of thousands of dollars, or even more, depending on the sort of care received; a single doctor’s appointment may cost a few hundred dollars. Many of us lack the financial means to cover such substantial bills in the event of illness, particularly since we have no idea when we might get sick or hurt or how much medical attention we would require. One method to bring down these expenses to more manageable levels is through health insurance.

Following are three important questions you should ask when making a decision about the health insurance that will work best for you.

1.Where can I receive care?

Influencing provider access is one method health insurance companies use to keep costs under control. Physicians, hospitals, labs, pharmacies, and other organizations are examples of providers. Numerous insurance companies have agreements with a designated network of providers who consent to provide services to plan participants at a reduced cost.

The insurance company may not pay for the service(s) rendered or may pay less than it would for in-network care if a provider is not in the plan’s network. This implies that the enrollee may be expected to pay a significantly larger portion of the bill if they receive treatment outside of the network. It is imperative that you comprehend this notion, particularly if you are not native to the Stanford region.

You might not be able to access the treatment you need in the Stanford area, or the cost of that care could be significantly higher, if, for example, your parent’s plan only covers providers in your hometown.

2.What does the plan cover?

Increased uniformity in insurance plan benefits is one of the outcomes of the Affordable Care Act’s health care reform initiatives in the United States. Prior to this kind of standardization, the advantages provided by different plans differed significantly. Prescriptions, for instance, were covered by certain plans but not by others. A variety of “essential health benefits” must now be provided by plans in the United States, and these include

Services for emergencies
Being admitted to a hospital
lab examinations
maternity and infant care
Treatment for substance abuse and mental health
Physicians and other services you receive outside of a hospital are considered outpatient care.
pediatric services, such as eye and dental care
prescription medications
Services for preventing (like some vaccines) and managing chronic illnesses
services for rehabilitation

It is crucial to find out “what does the plan cover” for our international student population, as they may be thinking about getting coverage through a non-US plan.

3.How much will it cost?

It might be difficult to determine how much insurance will cost. We discussed paying a premium in our review in order to sign up for a plan. You are aware of the upfront and transparent cost of this; you know how much you pay.

Regretfully, this is not the only expense you will incur for the services you receive under most plans. Accessing care usually entails costs as well. This expense is represented by the portion you pay out of your own pocket for medical care and is known as deductibles, coinsurance, and/or copays (see definitions below). Generally speaking, you will pay less when you access care the more you pay in premium up front. When it comes to accessing care, the lower your premium payment, the higher the cost.

Our students need to decide whether to pay a bigger portion now or later. You are responsible for covering the cost of any care you receive. We have adopted the stance that, in order to reduce expenses as much as possible at the time of service, it is preferable to pay a bigger portion of the upfront fee. Our reasoning stems from the need to remove any obstacles to care, like a high payment at the time of service, that would deter students from seeking medical attention. When medical attention is required, we want students to have access to it.

Leave a Reply

Your email address will not be published. Required fields are marked *