Insurance Basics: Home
After you get care, your provider sends a bill, or “claim,” to your insurance company. Your insurance company handles the claim and sends you an Explanation of Benefits (EOB).
Your plan contracts with a wide range of doctors and other practitioners, as well as hospitals, labs, radiology facilities, pharmacies and other providers. These are the providers in your “network”. Each of these providers has agreed to take your plan´s contracted rate as payment in full for services.
Medical supplies and equipment, such as bandages and wheelchairs, and ambulance rides are often listed separately on bills and Explanation of Benefits (EOB) forms.
Health plans negotiate the price of medical services with certain doctors, hospitals, labs and other providers.
New rules have expanded access to two types of limited health insurance plans. They are association health plans (AHPs) and short-term, limited duration (STLD) health plans. Because they don’t have to follow the Affordable Care Act, these plans can cost less than regular health plans. But, they have limitations you should know.
If you’re 65 or older, figuring out how Medicare works and when to sign up can be challenging. It can be hard to know what kind of coverage you’ll need. There are Part A, Part B, Part D, Medicare Advantage plans (Part C) and Medigap. There also are other complex terms to know. This article will cover the basics of what you need to know about Medicare.