how does medical insurance work

How does medical insurance work?

We can’t deny that however hard we try to stay away from sickness and disease, we will always be vulnerable to viruses, bacteria, and other harmful organisms that can cause us to get sick. This is why medical insurance is now a necessity instead of a privilege. Its main goal is to make it easier for us to obtain medical assistance anytime we need it. But how does medical insurance work? And does medical insurance cover dental check ups?

Medical insurance: At a glance

Medical health insurance covers the whole or a part of the risk of a person incurring medical expenses. It is between a person and an insurance company bonded by a policy that states all the details of medical conditions and requirements that the insurance covers, controls, and manages the cost.

How does medical insurance work?

We have to understand that medical insurance is not charity, it is a financial business first and foremost. An insurance company finds out how much one person can generally spend for each medical condition they cover and set a premium or fee for them to pay to be able to get insured. This process is called risk classification, and it undergoes a limited underwriting process.

For example, a person with diabetes wants to get insured. She fills out a form that shows her present and family medical history, including pre-existing conditions. The insurance company now determines which diseases she is prone to have in the coming years based on her medical history. They calculate the potential expenses and sets a monthly premium for her to pay so she can finally be insured for future use.

Does medical insurance cover dental check-ups?

how does medical insurance workUnfortunately, medical insurance policies are limited, even to the list of medical conditions it can cover. So there is a possibility that dental procedures may not be covered. However, it is still best to read the policy or inquire from the insurance provider if mere dental check-ups can be covered. Some have extras cover but with an additional fee, so it really is a must that you read and understand your medical insurance coverage from cover to cover so you can take advantage of all the perks and benefits.

What basic things should I know about my medical insurance coverage?

The monthly premiums. This is like your monthly bill for getting insured. The amount you have to pay is determined by the medical conditions that you are found to be at risk of having in the future, with the estimated medical expenses that it would take to have you covered. The premiums are set in such a way that it is a bit pricey for someone who wants to abuse the system but affordable enough for someone who does not necessarily need it.

Co-payments. There are insurance policies that require you to pay a percentage of the medical bill first to be covered. For example, for a $5000 bill, you have to co-pay 20% ($1000) so the company can cover the remaining ($4000).

Exclusions. Yes, unfortunately, there are medical procedures that may not be covered by insurance. Common examples are elective surgery and cosmetic surgery.

Annual coverage limits. This is the total amount that the insurance is going to pay for the whole year. Once you reach your coverage limit, everything you incur will be paid out of pocket. So make sure you know your policy’s annual benefit limit.

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