They used to tell us, “You can’t believe everything you see on TV.” But now that we’re doing everything online, this advice is more important than ever.
In this blog, we’ll talk about common misunderstandings people have about health insurance. These misconceptions can make it hard to know what’s true about coverage, costs, and who can get insurance. By clearing up these myths, I hope to help you make better decisions about your healthcare.
Whether you’re new to health insurance or you’ve had it for a while, this article will help you learn the truth about how it works.
Myth #1: Health Insurance covers all medical expenses
While health insurance is essential for covering a significant portion of medical costs, it doesn’t cover everything.
Most plans come with deductibles, copayments, and coinsurance, which means you’ll still have out-of-pocket expenses. Additionally, certain treatments, procedures, or medications may not be covered, especially if they’re considered experimental or elective.
Understanding your policy’s specifics and limitations is crucial to avoid surprises when seeking medical care. Moreover, factors like network restrictions and prior authorization requirements can also affect coverage, highlighting the need for careful evaluation of health insurance plans.
Myth #2: You only need health insurance when you’re sick
While health insurance is crucial for covering medical expenses when you’re sick, its value extends beyond just illness.
Many modern health insurance plans offer proactive benefits aimed at preventive care and overall well-being. These can include access to fitness center discounts, health tracking apps, preventive screenings, and wellness programs. By utilizing these additional benefits, you can maintain your health, prevent future health issues, and potentially reduce your healthcare costs in the long run. It’s essential to recognize that health insurance is not just for treating illness but also for promoting and maintaining good health.
Contact your plan’s member assistance line can help you explore these extra benefits and maximize your coverage.
Myth #3: Health insurance from one provider is the same as any other
Health insurance plans can vary significantly between providers in terms of coverage, costs, network options, and additional benefits.
All health insurance plans are categorized as Bronze, Silver, Gold, or Platinum, and plans within that category will have average benefits that are approximately the same. But while some aspects of coverage may be similar across plans, the devil is often in the details. Factors like deductibles, copayments, coinsurance rates, and out-of-pocket maximums can vary, impacting your overall healthcare expenses.
Moreover, different insurance companies may offer varying levels of customer service, access to healthcare providers, and options for managing your coverage. It’s essential to carefully compare different health insurance plans to find one that best suits your individual needs and budget. Simply assuming that all health insurance plans are identical can lead to overlooking crucial differences that may affect your healthcare experience and financial well-being.
Myth #4: Health insurance is too expensive for young, healthy individuals
While it’s true that health insurance premiums can seem costly, especially for those who are young and healthy, there are affordable options available.
Many health insurance plans offer a range of coverage levels and pricing tiers to accommodate different budgets. Additionally, young individuals may qualify for subsidies or tax credits through government programs, making coverage more affordable.
It’s also important to consider the potential financial consequences of being uninsured, such as unexpected medical bills in case of accidents or unforeseen health issues. Health insurance provides financial protection and access to preventive care, which can ultimately save money and safeguard one’s health in the long term.
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Myth #5: You can’t change health insurance plans once you’ve chosen one
Contrary to this belief, health insurance isn’t a one-time decision. You actually have the flexibility to change your health insurance plans during specific enrollment periods.
For instance, during the annual open enrollment period, which occurs once a year, you can review your current plan and switch to a different one that better suits your needs. Additionally, certain life events, such as marriage, divorce, birth/adoption of a child, or loss of other coverage, trigger special enrollment periods during which you can change your health insurance plans outside of the annual enrollment period.
Myth #6: You don’t need health insurance if you’re covered by worker’s compensation
While worker’s compensation may cover medical expenses related to work-related injuries or illnesses, it typically does not provide comprehensive health insurance coverage.
Worker’s compensation is designed specifically for injuries or illnesses that occur in the workplace and may not cover non-work-related medical issues or preventive care. Additionally, worker’s compensation benefits may be limited and may not cover all medical expenses or provide ongoing coverage for chronic conditions. Therefore, having separate health insurance coverage is important to ensure access to comprehensive healthcare services beyond what worker’s compensation may offer.
Myth #7: You can’t negotiate medical bills if you have health insurance
Having health insurance doesn’t mean you lose the ability to negotiate medical bills. In fact, it can sometimes provide leverage in negotiations.
If you receive a medical bill that seems high or unclear, you have the right to question and negotiate charges with your healthcare provider or the billing department. Even with insurance, there may be costs not covered or discrepancies in billing. You can ask for itemized bills, inquire about payment plans, or discuss options for reducing expenses.
Being proactive and assertive in discussing medical bills can often lead to cost savings, regardless of having insurance coverage.
Myth #8: Pre-existing conditions are always excluded from health insurance coverage
While it’s true that pre-existing conditions were often excluded from coverage in the past, this is no longer the case thanks to the Affordable Care Act (ACA).
Under the ACA, health insurance plans are prohibited from denying coverage or charging higher premiums based on pre-existing conditions. This means that individuals with pre-existing conditions cannot be denied coverage or charged more for their health insurance solely because of their medical history. Insurance companies are required to provide coverage for pre-existing conditions as an essential health benefit.
Therefore, individuals with pre-existing conditions can now access affordable health insurance coverage without fear of being excluded.
Myth #9: All medical services and treatments are covered equally by health insurance.
Health insurance plans do not necessarily cover all medical services and treatments equally. Coverage can vary depending on factors such as the specific plan, network providers, and medical necessity.
Some services or treatments may require pre-authorization or may be subject to limitations or exclusions outlined in the insurance policy. Additionally, plans may have different cost-sharing arrangements for various services, such as copayments, coinsurance, and deductibles. You should carefully review their insurance policy and understand what services are covered, what limitations apply, and how much you may be responsible for paying out-of-pocket for different types of medical care.
Myth #10: You can’t get health insurance if you’re self-employed or unemployed
This is not true. There are various options available for individuals who are self-employed or unemployed to obtain health insurance coverage.
For self-employed individuals, options may include purchasing individual health insurance plans through the Health Insurance Marketplace or directly from insurance companies. Additionally, some professional associations or organizations offer group health insurance plans for self-employed individuals.
For those who are unemployed, options may include purchasing coverage through COBRA (Consolidated Omnibus Budget Reconciliation Act) or enrolling in Medicaid or the Children’s Health Insurance Program (CHIP) if eligible. Furthermore, some states have expanded Medicaid eligibility, providing coverage to more low-income individuals. Therefore, being self-employed or unemployed does not necessarily mean you cannot access health insurance coverage.
Myth #11: Traditional Health Insurance is the Only Option
While traditional health insurance is widely known, it’s not the sole option for Americans seeking healthcare coverage.
Healthcare Sharing Programs, commonly referred to as “Healthshare,” are an excellent alternative to traditional health insurance. These programs operate on a community-based model rather than traditional insurance structures. Members contribute to a shared pool of funds, which are then used to cover eligible medical expenses of fellow members.
What’s remarkable is that Healthshare programs often come at a significantly lower cost compared to unsubsidized insurance plans, making them a viable and affordable alternative for many individuals and families. So, while traditional health insurance is familiar, it’s essential to recognize that Healthshare programs provide a distinct and cost-effective option for accessing healthcare coverage.
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We’re here to assist you in finding the right healthcare insurance program tailored to your needs!
If you have any questions about health insurance or healthcare cost sharing, trust HSA for America to provide clarity. With years of experience debunking healthcare myths, we’ve made health insurance more accessible and affordable.
Schedule a free consultation today by clicking here or visit the HSA for America blog for additional tips on health insurance, healthshare plans, and more.
Hi! I’m Mike Montes, and I’m one of your Personal Benefits Managers. I like working with HSA for America because we’re creating solutions to healthcare problems. Our focus on money-saving alternatives like HSA plans and health sharing programs, and the variety of health share programs we offer, are what set us apart. Read more about me on my Bio page.
