What does being covered by insurance mean?

It doesn't mean that the service is 100% paid. For example, in a plan where “urgent care” is “covered”, a copayment could apply. If a service is covered, it means that your health plan will pay part or all of the cost. Covered services often include regular doctor's office visits, tests, urgent and emergency care, hospitalizations, prescription drugs, medical equipment, and more.

In most cases, your doctor must also be on the list of doctors who accept your insurance; this list is also called an insurance network. Your health insurance policy is an agreement between you and your insurance company. The policy includes a package of medical benefits, such as tests, medications and treatment services. The insurance company is committed to covering the cost of certain benefits listed in your policy.

All health plans require you to pay part of the cost of your medical care. In addition to premiums, you usually have to meet a deductible and pay for copayments and coinsurance. Texas law requires some group plans to continue their coverage for six months after COBRA coverage ends. Your insurance company's decisions may mean that the test, medication, or service you need isn't covered by your policy.

To get the most out of your money, use the services covered by your health plan (and go to providers in your network) whenever possible. If you continue with HMO coverage and move out of the service area, the HMO will only pay for emergency care. Insurance companies can't terminate your policy if you made an unintentional mistake in your insurance application. Some plans may cover more services, such as dental and vision care for adults and weight management programs.

It's best to know how much your insurance company will pay before you get a service, take a test, or fill a prescription drug. If you don't qualify for the COBRA program, you can continue with state coverage for nine months after you finish your job. If you buy from an insurance company or the market, you can buy a plan that also covers your family. All plans, even plans through the same insurance company, cover different doctors, clinics, prescription drugs, and other services.

Insurance that you purchase directly from a company or through the marketplace is called individual insurance because it is sold to individuals, not to a group. COBRA is a federal law that allows employees to continue their health coverage for a period of time after leaving their job. Health care coverage helps you get the care you need and financially protects you and your family if you get sick or injured. If an HMO can't pay its claims, the insurance commissioner can assign HMO members to another HMO in the area.

Insurance companies can't stop paying your claims just because they've already paid a certain amount for your medical care. I recommend that you check that the care you want (and where you want to go) are covered before you schedule an appointment.

Carl Somilleda
Carl Somilleda

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