Healthcare is a complex subject and can be incredibly confusing to the point where it becomes stressful. Yet it is an essential aspect of everyone’s life, now more than ever with lifespans becoming progressively longer and with an increasingly aging population. That’s why it’s important, despite any initial confusion, to delve in and understand the basics.

Are Healthcare and Health Care the Same Thing?

They are often used interchangeably, but there may be some differences depending on whether you are in North America or the UK. Healthcare generally refers to the system that provides the care individuals need, whereas health care refers to specific actions like medical visits or prescribing medicines.

While services intended for maintaining health are important, in the event of an illness or accident, it’s important to know what services are available, where to turn, and what to do. A critical health issue can be stressful enough for the ill, but equally as problematic for family members or legal guardians. 

Navigating doctors, exams, treatments, and insurance companies can be overwhelming for all involved. The more you understand, the better you will be able to manage.

The Healthcare System in the United States:

The United States is the only developed nation where the government does not provide health services or medical benefits to its citizens. To receive medical care in the U.S., it must be paid for, and it is incredibly expensive. 

A three-day visit to a hospital can cost tens of thousands of dollars depending on why you are there. If you do not have insurance, you must pay medical expenses out of pocket.

Due to these facts, most Americans opt to purchase health insurance. This insurance protects you from becoming extremely indebted to hospitals, medical professionals, etc. if you become ill or are involved in an accident. Regular premiums are paid, and the insurance company will pay all or a portion of your medical bills depending on the policy.

Health insurance can be purchased in a private marketplace or may be provided by the U.S. government to specific categories like the military or veterans. Policies can be purchased from both, non-profit and for-profit insurance companies. 61% of all health insurance coverage is furnished through employment.

Health insurance providers will have you select a PCP or Primary Care Provider from their network of medical professionals.

A PCP can be a doctor or a nurse practitioner. This is the person you will see if you become sick, have a chronic condition, or require lab exams.

Generally, medical care takes place by appointment. If you are ill, the appointment will be arranged quickly. If you need exams, you may have to wait for your appointment. Most healthcare insurance providers will offer urgent care services as well as emergency coverage.

HMOs, PPOs, Medicare, and Medicaid:

Health insurance providers use two basic kinds of service providers: Health Maintenance Organizations and Preferred Provider Organizations. Both are pre-paid.  An HMO will connect the provider with those that furnish services. A PPO offers a preset group of hospitals and physicians for medical care. 

Medicare and Medicaid are both public health insurance offerings. Medicare is designed for the aged and disabled with a “Part A” covering hospital care, some nursing homes, and home health services. “Part B” is a supplemental option to cover physician, outpatient hospital and laboratory services, radiology, and some home health services. 

Part A is tax-funded, while Part B requires payment of a premium. Medicare also requires a deductible and various co-payments. Those eligible to select Medicare often purchase Medigap coverage as well. Medigap is offered by private insurance companies to pay for what Medicare does not cover,

Medicaid is a public health insurance option designed for economically disadvantaged groups, however, eligibility varies from state to state with some states being more generous to the insured.

Healthcare and Health Insurance:

Health insurance is simply a method to pay for your health care. It protects you from having to pay all the expenses of medical treatment. Americans 65 or older are eligible for Medicare. Those under age 65 may have health insurance through their employment. If not, they can purchase health insurance from a private insurance company.

Health Insurance Payments and Their Function:

The monthly premiums you pay will cover the costs of all or a portion of the medical treatments you receive. Many will not only include medical appointments and treatments, but prescriptions, well-being expenses, and customer service.

When selecting a health insurance plan, consider the monthly premium, the services offered, and the benefits granted. It is equally important to evaluate deductibles and out-of-pocket expenses detailed in your policy.

  • Insurance Riders – these are optional coverages that can cover something a standard policy does not for an additional cost.
  • Deductible – if your deductible is $500, you will pay the first $500 for any medical treatments you receive. Once the deductible is paid, your insurance provider will cover other healthcare expenses depending on the coverage you have purchased.
  • Co-payments – this is a flat fee you may be required to pay for an emergency room visit or a doctor’s visit.
  • Co-insurance – this is a fee that you may pay for some covered services like a special test or visit.
  • Out-of-Pocket – your policy may have an out-of-pocket maximum which will place a limit on how much you must pay annually for any treatment received from hospitals or doctors in the provider’s network. After the maximum is reached, your insurer will pay the rest.

Health Insurance Can Relieve Stress:

The cost of health insurance can be a drain on anyone’s budget. That is why understanding the healthcare system and selecting the best health insurance is vital to your and your family’s peace of mind.

Health issues can be stressful enough. Being ill-prepared in the event of an emergency or serious illness can only increase that stress one hundred-fold in the worst possible moments.