Individual Health Insurance | TN
The need for health insurance in Tennessee
Most people believe that having health insurance is very important, yet many Tennesseans still choose to go insured. The Affordable Care Act and Marketplaces will change that for millions of us. We all know that insurance protects you from high costs when something bad happens. No one plans to get sick or hurt, but most people need to get treated for an illness or injury at some point, and health insurance helps pay these costs. You get health insurance to protect you when you need serious medical care, but it's also there for routine check ups and prevention.
Understanding how health insurance works helps you be an informed consumer so you can find coverage that fits your needs.
Health insurance is a contract between you and your insurance company. You buy a plan or policy, and the company agrees to pay all or part of your medical expenses when you get sick or hurt. A standard health insurance policy also gives you access to preventive care to keep you healthy, like vaccines and check-ups. Many plans also cover prescription drugs.
How Health insurance helps you pay for care
Many people don't realize the average cost of a 3-day hospital stay is $30,000. Or that fixing a broken leg can cost up to $7,500. Health insurance can help protect you from unexpected costs like these.
Your insurance policy will show what types of care, treatments and services are covered, including how much the insurance company will pay for different treatments in different situations. One of the biggest values you get with health insurance is the pricing power of a big insurance company. By using an "in network" provider you will receive reduced rates on everything from doctor visits and prescriptions to tests and hospitalization.
Health Insurance Costs in Tennessee
Your monthly insurance premium is only part of the cost of health care. When you go to the doctor or hospital, you may be responsible for a co-pay for the doctor and prescriptions. You may also have to meet an annual deductible before the insurance company starts to pay its share. How much you pay for your premium and the amount of your annual deductible is based on the type of insurance you have.
Just as important as the premium cost is how much you have to pay when you get services. Examples include:
- How much you pay before your insurance coverage starts (a deductible)
- What you pay out-of-pocket for services after you meet the deductible (coinsurance or copays)
- How much in total you'll have to pay if you get very sick or have a bad accident (the out-of-pocket maximum)
What your policy covers is often directly related to how expensive the health insurance policy is. The policy with the cheapest premium may not cover as many services and treatments. You can also visit our Health Insurance 101 page for more information.
5 things everyone must know about health insurance in Tennessee
- There are many kinds of private health insurance policies. Different kinds of policies can offer very different kinds of benefits, and some can limit which doctors, hospitals or other providers you can use. You can choose from PPO, HMO, or ACO . It is very important for you to get help from a professional if you don't understand the difference in these types of plans. Choosing the right plan before you need it will save you a lot of frustration, time and money when you do.
- You may have to pay coinsurance or a copayment as your share of the cost when you get a medical service, like a doctor's visit, hospital outpatient visit or a prescription. Coinsurance is usually a percentage amount (for example, 20% of the total cost). A copayment is usually a set dollar amount (for example, you might pay $20 or $40 for a prescription or doctor's visit).
- You may have to pay a deductible each plan year before your insurance starts to pay. For example, your plan may have a $1,000 deductible. If the total cost of your doctor visit is $1,250, you pay the first $1,000 to cover the deductible, and then your insurance starts to pay its share (coinsurance).
- Health insurance plans contract with networks of hospitals, doctors, pharmacies, and health care providers to take care of people in the plan. Depending on the type of policy you buy, your plan may only pay for your care when you get it from a provider in the plan's network, or you may have to pay a bigger share of the bill. You don't want to go out of the network unless it is an emergency.
- You may see products that look and sound like health insurance, but don't give you the same protection as full health insurance. Some examples are policies that only cover certain diseases, policies that only cover you if you're hurt in an accident, or plans that offer you discounts on health services. Don't mistake insurance-like products for full comprehensive insurance protection. Full health insurance usually covers most medical problems. You get what you pay for with insurance. If it sounds too good to be true, it probably is. It's better to get a second opinion than buy the wrong insurance policy.
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