Because of the matter of human dignity, everyone is entitled to health care like the basic elements in life. The healthcare sustains us and should always be accessible and affordable for everyone with no exceptions and interruptions. The healthcare cost continues to grow faster than the economy as a whole. People also feel the pinch when they have to make the payments for the services which are not covered under their health insurance policies.

The consequences of being uninsured are significant. Because uninsured patients do not receive the right care in the right place. It is easy to be critical of the affordable health care act, but coming up with a workable solution is difficult. In the health and wellness sector, to get affordable health care it is very important to understand the health insurance effectively.

Below are few key concepts, which will help you to understand the health plan wisely and how you can avoid the financial healthcare problems –

  • Cost sharing - Do you know your healthcare insurance won’t pay all of your covered health care expenses? This comes under the cost-sharing, as you have to share your health care bills with your health insurance company.

The cost-sharing mechanism includes –

Deductibles – You have to pay each year before your health insurance coverage begins to pay its share fully. But thanks to the affordable health care act, your health insurance company has to pay for your preventive health care without requiring paying the deductibles first.

Co-payments - The small amount you pay each time for the small heath care services.

Co-insurance - Is the percentage of the bill you pay each time when you get a particular healthcare service.

  • Out of Pocket Maximum – Once you have paid all your deductibles, co-pays and coinsurance to equal your health plan’s, your health insurer will begin to pay 100% of your covered health care expenses for the rest of your life.
  • Network Provider – Most of the health plans in your insurance policy also have the health and wellness center providers that have made a deal with the health plan to provide service at the discount rates. The health plans include doctors, hospitals, physiotherapist, x-rays etc.
  • Prior Authorization – The health insurers use the pre-authorization requirements. You just need to get the health plan permission before you get any type of healthcare service. As your health plan is paying your part of the bill so they want to make sure you are actually getting a health care service.
  • Claims – A health insurance claims is the way many health plans are notified about the health care bills. If you use the health plans network provider, they will automatically send the claim to your health insurer. But when you feel your health insurer will not pay the claims, you should file a complaint against it.
  • Premiums – The money which you pay to the health insurance is called premiums. The premium is very important and you have to pay this every month.
  • Open Enrollment and Special Enrollment – You can’t sign up for health insurance whenever you want. There is an open enrollment period for every employer each year, where they can sign up for health insurance. The special enrollment period is for those when someone has lost their existing health insurance or has to change the family size. In special enrollment, you are allowed to sign up health insurance when there is n open enrollment.

It is very important to understand your health care plans, because if you don’t understand your health care cost sharing than you will not be able to pay for any healthcare service. Enacting health reform is a challenging task. But achieving affordable health care for all will be worth the effort.

Author's Bio: 

I'm a writer; illustrator, columnist and an editorial fellow. My previous work includes roles in digital journalism and content writer. I did graduation in Journalism