Insurance Basics: Home
The Affordable Care Act (ACA) of 2010 makes it easier for many Americans to get health insurance. It also expands the services that health plans need to cover.
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.
Most medical plans do not include coverage for many dental services. Often, dental services are covered under a separate plan. Like medical plans, most dental plans have specific out-of-pocket costs, like coinsurance, copayments and deductibles.
Most health plans cover medically necessary visits to an eye doctor. Sometimes they cover routine eye exams too, but to get complete vision coverage you may have to go to other sources. This article will tell you about those sources.
Suppose your insurer won´t pay for a healthcare service, or pays less than you had expected. You have the right to “appeal”, or ask for your case to be formally reconsidered.
To look up the estimated costs for behavioral health services (including mental health and alcohol and/or drug services), go to our home page, fairhealthconsumer.org, and click on Medical and Hospital Costs.