How Does Health Insurance Work?

Health insurance is an essential aspect of every individual’s life. It provides protection from the exorbitant costs of medical care and ensures that you receive necessary medical attention in case of an emergency. In this article, we will explain how health insurance works, the different types of policies available, and how to choose the right one that suits your needs and budget.

What is Health Insurance?

Health insurance is a type of insurance that provides you with financial protection in case of illness or injury. It covers the cost of medical care, including hospitalization, surgeries, tests, and medication. Health insurance policies range from basic to comprehensive, and the type of policy you choose depends on your requirements and budget.

Types of Health Insurance Policies

There are two primary categories of health insurance policies, which include:

Types of Health Insurance Policies
Indemnity Plans
These policies allow you to visit any doctor and hospital you prefer. You pay for the services upfront and submit a claim to the insurance company for reimbursement.
Managed Care Plans
These policies offer a network of healthcare providers with whom you have to avail services. They are more affordable and have lower out-of-pocket costs compared to indemnity plans.

In addition to these primary categories, you can also find a range of specialized policies that cater to specific needs. For instance, critical illness insurance covers the cost of treatment for specific diseases such as cancer, stroke, and heart attack.

How Does Health Insurance Work?

Health insurance policies work by paying for the cost of medical care that you receive. You pay a monthly premium to the insurance provider, and in return, they cover the cost of your medical expenses. Depending on the type of policy you have, you may have to pay a deductible, copay, or coinsurance.

A deductible is the amount you pay before your insurance kicks in. For example, if you have a $1,000 deductible and receive medical care worth $5,000, you will pay the first $1,000, and the insurance company will cover the remaining $4,000.

Copay is a fixed amount that you pay for essential medical services, such as doctor visits or medication. Coinsurance is the percentage of the cost of medical care that you have to pay. For instance, if your coinsurance is 20%, and your medical bill is $1,000, you will pay $200, and your insurance provider covers the remaining $800.

Factors to Consider When Choosing a Health Insurance Policy

Choosing the right health insurance policy is essential to ensure that you have adequate coverage for medical expenses. The following factors can help you make an informed decision:

Network of Healthcare Providers

If you have a preferred doctor or hospital, ensure that they are part of the insurance provider’s network. Or you can opt for an indemnity plan that allows you to visit any healthcare provider.


Look for a policy that offers comprehensive coverage, including hospitalization, outpatient care, prescription drugs, and emergency services.


Consider the monthly premium, deductible, copay, and coinsurance before choosing a policy. Ensure that the policy covers your medical needs without straining your budget.

FAQs on Health Insurance

1. What is a pre-existing condition?

A pre-existing condition refers to any illness or injury that you had before buying the health insurance policy. The insurance provider may not cover the cost of treating pre-existing conditions for a specific period, typically six months to one year, depending on the policy.

2. Can I add my family members to my policy?

Yes, you can add your spouse, children, or parents to your health insurance policy. However, you may have to pay an additional premium for each family member you add.

3. Can I change my policy mid-year?

You can change your policy mid-year during the open enrollment period typically held every year. However, you may have to pay a penalty or wait until the next enrollment period if you miss the deadline.

4. What happens if I lose my job?

If you lose your job, you can continue to avail of the health insurance policy offered by your employer through COBRA. However, you will have to pay the entire premium, which may be higher than what you paid when employed.

5. What is a lifetime limit?

A lifetime limit refers to the maximum amount that an insurance provider will pay for medical care over your lifetime. Most policies do not have a lifetime limit, but some may have a cap on the maximum amount they will pay.


Health insurance is a necessity that provides financial protection from unexpected medical expenses. It is essential to choose the right policy that meets your medical needs and budget. By considering the factors discussed in this article and understanding how health insurance works, you can make an informed decision and avail of the best possible coverage.