How does health insurance work?

Can someone please explain to me how health insurance works. I'm 18 and I know i'm supposed to know how it works but I dont. I'm getting older and these are things I need to know. If you could explain how it works with having a job, why people cant get it, etc... I want to know any and everything you can tell me. Thanx 10 pts best answer.

There are many kinds of health insurance, so this is a complex question. And there are several ways you get it as well.
Types: The major types are 1. a HMO (health maintenance organization--Kaiser is the prototype). In this type of insurance you must use all the facilities that ascribe to the HMO. To go out side with out prior approval is to risk having to pay for it all. This is generally the cheapest form of insurance. 2. The PPO (preferred provider org); a bit more $. You have to use all the services that are in the PPO network; but its may be more widespread than the HMO. Again, to use a non PPO provider increases the amount you have to pay out of pocket. 3. Open networks--the most $$. You go where you want, when you want. There are several of these out there with various names. Boutique medicine is medicine you pay for entirely.
Some terms: DEDUCTIBLE-this is the amount of $ you must pay before the insurance kicks in. Like car insurance. The higher the deductible, the cheaper the insurance. CO-PAY-this is the amount of $ that you are reasonable for and it depends on each charge. To have a Dr's visit you might have a co-pay of $10; which is due at to the Dr at the time of the visit. LIMITS--the amount at which your insurance ceases coverage (say 1 million). This is important in catastophic ilness or trauma. INCLUDED/EXCLUDED--procedures that are covered or not (such as maternity care or ER visits). ER visits often have their own set of rules & a higher co-pay. PREMIUM--how much the insurance actually costs yearly/monthly. (In addition to other fees). % COVERED--you insurance may only cover, say 80% of out patient testing--you pay the other 20% (in addition to co-pay etc).
How to get insurance? The cheapest is a group plan; which is what employers offer. The group usually negotiates cheaper costs. The employer pays part of the premium. Individual coverage is what a person gets on his own because his employer doesn't cover insurance. This can be $$$$. You must pay everything. You can still elect for a HMO, PPO etc but you pay the full premium.

So what are all the charges summarized? 1. The Premium 2. the Co-pay 3. the deductible, and 4. the non-covered %.

You must select a policy that affords the best coverage to you as you think you will use it. Luckily at your age, health insurance is cheap!

I hope this brief intro helped!!!!

You've asked a very broad question. There is no simple answer.

In truth, health insurance works a little differently in each state.

Health insurance is not compulsory for everyone. If you're lucky, you are able to join a group policy at work. (If you're really lucky, it's a good policy and the employer pays at least half of it.) Some states have recently made it compulsory, but that's such a recent change that there's no clear cut answer yet for how that's going to work.

What happens if someone can't afford it is... they don't get it, usually. Except if your income puts you below the "poverty level", in which case you qualify for Medicaid. (In some states there are programs that typically provide assistance with insuring children, though they are few and far between for covering adults.)

Health insurance rarely covers all the bills when you have a procedure done. Most plans cover 50-80% after you meet your deductible. The deductible amounts vary widely (but the trend is that the deductibles are getting higher and higher to keep the premiums down.) If you're really, REALLY lucky, you don't have a deductible (which is only an option on group plans), and you may only have to pay 10% of covered charges. (These plans are few and far between. As in, you might have them if you're in Congress.)

In the end, as with most things, the middle class takes the brunt of these costs. This has become such a problem that more than 50% of all bankruptcies are as a result of medical bills (and of those, more than 75% had health insurance.)

It's complex so ill just explain some things briefly. People used get healthcare with their jobs but bc stockholders and businesses need to make more money, they decided to get rid of that, this is one reason ppl don't have healthcare or underinsured. Companies used to pay for their employees 100%, but then to cut costs, employees must now pay for some percentage like half into the health program. There are also co-payments which means less money for employee. People can get free health - medicaid, but some people make too much for the gov program.

On a different note, you must also understand insurance. Insurance companies are in it to make money, not lose. So people who are sick will have to pay higher premiums or not get any at all. That's why you might hear stories of ppl getting denied.

You can watch the documentary by michael moore, "sicko"

You buy the coverage when you're healthy - because once you get sick, it's too late to buy insurance. Then, you pay the monthly fee, and submit claims.

Each plan works differently. There are WAY too many options to explain, in 1000 characters.

You know you are the biggest B*IT CH. I was having a BAD DAY and you made it worse!!! Thanks alot!!!!

I just came across this website, you may find many useful information on health insurance quotes, hopefully may help you:

http://all-health-insurance-quotes.blogspot.com

i look around on the web and found this site about healt insurance

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