Health Insurance

Health insurance is a contractual agreement where individuals pay premiums to an insurance company in exchange for financial coverage for a portion of their medical expenses. It provides financial protection and access to health care services for individuals and families. 

J.S. Edwards & Sherlock Insurance Agency’s team of experts can help you navigate various health insurance plans and options and find the best coverage for your needs and budget. 

What Does Health Insurance Cover? 

Health insurance typically covers a wide range of health-related expenses, which may vary depending on a plan’s details. Commonly covered services include hospitalizations, surgeries, doctor visits, prescription medications, laboratory tests, preventive care (e.g., vaccinations and screenings) and certain medical treatments. The extent of coverage can vary by plan, so it is important to review the policy terms and conditions to understand what services are included and any limitations or exclusions. 

How Does Health Insurance Work? 

Health insurance may help lower the amount policyholders would otherwise have to pay for high-cost medical care. To better understand coverage, the following key terms should be understood: 

• Premiums—Policyholders pay a monthly or annual premium to maintain their health insurance coverage. The premium amount may vary depending on factors such as age, location, medical history and the type of plan.

• Deductibles—Before insurance coverage kicks in, individuals must meet a deductible, which they must pay out of pocket for covered services.

• Copayments and coinsurance—Once the deductible is met, policyholders may be required to pay copayments or coinsurance for certain services. Copayments are fixed amounts (e.g., $20 for a doctor's visit), while coinsurance is a percentage (e.g., 20%) of the total cost of a service.

• Out-of-pocket maximum (OOPM)—Insurance plans also have an OOPM, the maximum amount individuals must pay during a policy year. Once this limit is reached, the insurance company covers 100% of remaining eligible expenses.

What Is a Health Insurance Deductible? 

Before health insurance coverage kicks in, individuals must meet a deductible, which establishes a minimum amount that must be paid out of pocket for covered services. After meeting the deductible, your insurance starts sharing the cost of covered services. Deductibles are usually reset annually. Some plans cover preventive care before meeting the deductible, and copayments or coinsurance may apply afterward. 

Contact Us 

J.S. Edwards & Sherlock Insurance Agency can help you determine the best health insurance coverage option for your needs and budget. Reach out to an agent today to learn more about health insurance by calling 409-832-7736.