Health Insurance

Your Guide to Health Insurance

Navigating the world of health insurance can be pretty confusing. Luckily, you don’t have to do it alone.

This guide will help you understand:

  • How health insurance works.
  • How to choose a health plan.
  • How to work with an agent (like us!).

Once you know how the health insurance world operates, you’ll feel a little better about that next visit to the doctor or calling to fill that new prescription.

And you’ll have a dedicated health insurance team member at Alliance assisting you along the way.

How Health Insurance Works

Health insurance some similarities – and some big differences – with the types of insurance you’re probably more familiar with like auto and home.

The basic premise is the same. You pay an insurance company a premium and they agree to help cover the costs of a particular risk, in this case your health.

So if you have a health problem that is covered under the policy, your insurance helps pay for costs that may come up, such as:

  • Medical Exams
  • Prescribed Medication
  • Surgical Procedures
  • And other covered options.

NOTE: The items above may not be covered under your policy!

Coverage and reimbursement change depending on your policy and your carrier, so make sure to check to see what YOUR policy covers.

But in general, the above items are a good idea of what your health plan will probably cover. Things like going to the doctor for a checkup, medication you might take for a medical condition, or a surgery you might have to have after an accident, all of these are classic examples of a health claim.

Most health insurance policies will have a deductible, or the amount that must be paid by you, the policyholder, before your insurance company starts to pay. While this may sound like a bad deal, it is there to help lower the cost of a policy. The higher amount you are willing to pay up front, the lower amount you pay for the policy as a whole.

NOTE: Not all claims count towards your deductible. Check your plan to see what falls under your deductible and what may not.

Another feature of your health insurance policy is a copay. A copay is an agreed amount you pay up front when you visit your doctor or get your medication. It is different than a deductible as a copay is always there and is always paid – another way you pay a little up front to help bring the overall cost down.

The last part of your health policy that you should know about is coinsurance. This part of coverage means the percentage of the covered claim that you pay.

For example, if your coinsurance is 15%, you will pay that percentage of the amount for a covered surgery and your policy will pay for the rest.

So now you should have a better idea of what your policy covers and how the different parts of it work.

But what about getting a policy? What should you look for, and what is the best way to buy it?

How to Choose a Health Plan

Selecting the right health plan for your situation is a vital step to staying healthy.

But in such a confusing world of different insurance companies, hospitals, doctors and changing regulations, what is the best way forward?

Most of us have three options:

  • Obtain health insurance through your employer.
  • Purchase a plan on the ACA website
  • Use a health insurance agent to find policy options.

All of these options have their strengths and weaknesses. Using your employers health insurance plan is often reasonably priced (sometimes they pay for all of it), but you lack options. Purchasing through shows you many choices, but you have no guidance in determining what plan is better than another.

With a health agent, you get the guidance you need to know which plan options you have based on your location, medical history, and employment status. You also get the choice of several different plans that can accommodate just about any situation.

Select the option that best fits you and your life. If you’re having trouble deciding, or if you want the third option, we’re happy to help.

But what does working with a health insurance agent look like?

First, a health agent will get to know you to help find a policy that is appropriate for your life. They will need to know things like:

  • Your personal info (age, address, SSN, etc.)
  • Family members that will be on the plan.
  • Your medical history.
  • Doctors or hospitals you prefer.

There may be more information that is needed, but this should be enough to get your agent on the way to giving you the guidance you need to get the right policy.

Not only that, but your agent can then help you select the policy, pay for it, and set it all up.

Which leads us to our next topic.

What Factors Influence Health Insurance Cost?

Knowing how a company comes up with your health insurance premium is a big bonus.

It helps you know what to expect when it comes to your plan, and if the cost is a fair one. Of course, your agent will be incredibly important to helping you know if something is fair.

Health insurance, like most insurance policies, is based on the concept of risk. The more likely a policyholder is to have an accident, the higher the cost of the policy.

The following are some of the factors that determine the price of health insurance:

  • Local regulations – Your state’s laws and federal laws determine a lot of what insurance companies are allowed to do.
  • Age – Different ages have different health risks.
  • Rural or Urban – Costs tend to be higher in rural areas and lower in urban areas.
  • Tobacco – Smokers are typically more expensive to insure.
  • Other health conditions – Some preexisting health conditions may make you more expensive to insure.

While there may be other considerations to how much your health insurance is per year, this should give you a good idea of what might make up that number on your bill.

Buying a Health Policy

Unlike most other types of insurance, health insurance can only be bought during special times of the year.

Open Enrollment is the period when buying a health policy is possible.

Currently, the Open Enrollment period is November 1st and lasts until January 15th.

If you still haven’t figured out what kind of health insurance you need by this time, get in touch with a health insurance agent ASAP (click the link below).

But if you need a health policy during another time of year, you must meet certain requirements to get one:

  • Married – Getting married allows you to get a plan after the wedding.
  • New baby – If you’ve given birth, adopted or otherwise have a new child, you can shop for health insurance.
  • Divorced or separated – If you have changed your marital status, you can find new coverage for your health insurance.
  • Deceased – The family’s of deceased individuals can end or get new policies for themselves.

If you think you have a situation that should lead to you buying a policy outside of Open Enrollment, ask one of our health agents if you qualify.

Which leads to our last point.

We Can Help with Health Insurance

We have been helping individuals and families in North Carolina with health insurance for years. We are lucky to have some of the top agents in the health world call Alliance their home, and they would be happy to walk you through finding the coverage you need.

This article should give you a good idea about the basics of health. But that doesn’t mean you can do it all on your own.

For most of us, health insurance is still a confusion maze of policies, regulations, HMOs and PPOs and EPOs and lots of other abbreviations.

You shouldn’t have to go it alone and guess what is right for you.

And the best part is, you don’t have to.

Click the link below and tell us who you are. A health insurance team member will contact you to help you get the coverage you need.

Life is too short to roll the dice with your health. Let’s get you covered the way you deserve.


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Are you ready to save time, aggravation, and money? The team at Alliance Insurance is here and ready to make the process as painless as possible. We look forward to meeting you!

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