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How health insurance works: The ultimate guide


Picking a health care plan can be intimidating. Between the unfamiliar terms, mysterious acronyms, health savings accounts and optional coverage, there’s a lot to get up to speed on. Wouldn’t it be great if you could find all the information you need on how health insurance works in one place?

Well, you’ve come to the right page. Here we break down everything you need to be prepared for open enrollment, the annual period when you choose your health coverage for the year ahead. No need to study it all ― pick and choose what feels most relevant to your life. Before you know it, you’ll be ready to select your coverage with confidence.

1. What are premiums, deductibles, coinsurance and copays?

Many people’s first question is about where their money is going. These insurance terms refer to different kinds of payments that consumers are responsible for. The amount you’ll pay varies from plan to plan: For instance, higher premiums often mean lower deductibles. Learn what each term means by watching the short video, then read the customer scenarios to discover which plan makes sense for your life.

Explaining premiums, deductibles, coinsurance and copays

2. What’s the difference between an HMO, POS, PPO and HDHP?

Each of these acronyms stands for a type of health care plan that lets you access doctors and services in a different way. Some plans require referrals to see a specialist while others do not; some plans offer a nationwide network of doctors, while others have a local focus. In the video, you’ll find out what makes each plan special. Read the customer stories to figure out which one fits your needs.

HMO, POS, PPO and HDHP: What’s the difference?

3. FSA vs. HSA: How do health care accounts work?

If you like saving money, you’ll want to know more about Flexible Savings Accounts and Health Savings Accounts. Both let you deposit pre-tax dollars to cover health care expenses, saving you about 30 cents on the dollar. Find out the unique advantages of each account in the short video. Customer profiles can help you decide which account is right for your financial and health goals. Then learn about eligible expenses you can pay for with your health account.

HSA vs. FSA: Which health savings account is right for you?

Can I pay for that with my HSA?

4. What perks can I get through my health insurance?

Your health plan may offer benefits you don’t know about…but should. Some will subsidize your gym membership; others have a medical hotline you can call 24/7. Read about other perks you might have access to, so you can make the most of your health insurance.

Lesser known perks your health plan may offer

5. Is vision insurance worth it?

Most medical plans don’t cover prescription glasses and contacts. For that, you’ll need to supplement your plan with vision insurance. Even if you have great vision, an annual eye exam can catch early signs of general health problems.

Learn more about the benefits of regular eye exams.

6. Does my situation require special insurance coverage?

Vision insurance isn’t the only way you can supplement your medical plan. During open enrollment, you may be offered optional, or “voluntary,” plans to cover dental expenses, hospitalization, disability and more. Watch the video to discover more about your choices, then read the article to see how other people selected extra coverage based on their health and budget.

Do you need special insurance coverage?

7. What health care decisions do I need to make when I get pregnant?

If you’re hoping to get pregnant in the coming year, you’ll want to check potential plans for their maternity and newborn coverage. Is your hospital or birthing center in-network? Does your carrier offer breastfeeding education and support? Learn more about what to look for in a health plan when you’re expecting to expect.

5 health care questions to ask when you’re starting a family

8. Where can I get health coaching and other special support?

Does your health insurance provider support you outside the doctor’s office? When you’re selecting a plan, ask about programs that help you achieve your health goals. For example, some plans will connect you to one-on-one coaches with expertise in smoking cessation, weight loss, infertility, sleep problems, stress reduction or condition management.

9. What digital health tools are available to me?

There’s no substitute for human support, but sometimes the right digital tool is all you need. Some plans give you access to a suite of health tools that can deliver health information whenever and wherever you are. Teladoc, for example, allows users to video-chat with doctors from a computer or smartphone for a preliminary diagnosis. Cost estimator tools can help you predict fees for a variety of tests and procedures. These are just two ways that technology can improve your health care experience ― and your health.

Learn more about digital tools available to Aetna members

10.  When can I change my health plan outside open enrollment?

Open enrollment is the annual window when you can make changes to your plan or choose a new one. But some special circumstances ― called qualifying life events ― allow you to make changes outside that window. Find out which planned or unexpected occasions allow you to update your plan.

When can you change your health insurance?


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