Health insurance is a vital investment that covers the costs of medical and surgical expenses incurred by an individual. It can provide peace of mind knowing that you are prepared for unexpected medical emergencies, but one of the most common questions that arise when you purchase health insurance is “How soon can I use my health insurance?”
Let’s explore the ins and outs of health insurance and the answer to this frequently asked question.
Understanding Health Insurance
Health insurance is an agreement between an individual and an insurance provider that provides coverage for medical and surgical expenses. The coverage they provide varies based on the type of policy you purchase.
The two primary forms of health insurance are:
- Fee-For-Service
- Managed Care
Fee-For-Service Insurance
Fee-For-Service health insurance plans offer more flexibility in choosing healthcare providers but come with higher out-of-pocket costs. Most Fee-For-Service plans may require you to pay out-of-pocket expenses before they cover any charges.
The plan will reimburse for medical bills based on a prearranged fee schedule. You can select the healthcare providers you want to use, but be aware that not all healthcare providers will accept the insurance. If your physician is not a part of your plan, you’ll have to pay a higher fee for their services, which may not be covered by the insurance.
Managed Care Insurance
Managed Care Insurance plans cover medical expenses in exchange for cheaper rates. In this type of plan, there is a network of healthcare providers who are considered to be a part of the plan’s provider network. In case you opt for medical services outside of your chosen provider network, you may end up paying more out-of-pocket expenses.
Managed Care Insurance has three different types:
- Health Maintenance Organization (HMO)
- Preferred Provider Organization (PPO)
- Point of Service Plans (POS)
Health Maintenance Organization (HMO)
HMOs are managed care plans that restrict you to a network of healthcare providers. The primary care physician determines your care, which means you need a referral from your primary care provider to see a specialist. If you visit another provider outside of your network or without a referral, you may need to pay out-of-pocket expenses.
Preferred Provider Organization (PPO)
PPOs also have a network of healthcare providers, but visiting providers outside of it is allowed, although it may come with higher out-of-pocket costs. This type of plan grants more control over the healthcare providers you see, with fewer restrictions on referral requirements.
Point of Service Plans (POS)
POS plans combine the elements of both HMOs and PPOs. They offer more appearance but generally come with higher out-of-pocket expenses, and the primary care physician determines your care.
When Can I Use My Health Insurance?
As soon as you have initiated the policy, you have access to some benefits. Still, it is best to ensure that your account is active with the insurance provider or policyholder to avoid any unnecessary costs, such as those for services given or carried out during a transition period.
When your new policy becomes active, you may begin using the benefits it provides. However, the waiting period, which may be as long as three months before the policy begins providing full benefits, particularly for pre-existing conditions.
You must confirm with your insurance provider to determine the list of services covered, how much you may be needed to pay for the services, when precisely you are eligible to receive full benefits, and if you are required to obtain approval from your insurance company for any specific types of medical care or treatments.
What Does My Health Insurance Cover?
Depending on the type of health insurance coverage you have, your policy can cover the following:
- Doctor’s visits
- Surgical procedures
- Hospital stays and other healthcare facilities, such as a skilled nursing facility or rehab center
- Prescription drugs
- Mental health services
- Rehabilitation services
- Pregnancy and childbirth-related services
- Lab tests and screenings
- Preventive services, such as immunizations and wellness visits
Still, every health insurance policy is different. It is essential to read the details of the coverage your policy provides and know the exceptions and restrictions listed in the insurance contract. Every policy has some limitations and includes various benefits which may include exclusions for some conditions.
How Do I Get Medical Care When My Policy Hasn’t Started Yet?
If you require medical attention but have not received your insurance card or confirmation of coverage, call the insurance provider directly to validate the policy. Some insurance companies’ websites allow you to access and download a temporary identification card with your policy number. In case it’s not provided, the insurance provider may send a fax to the doctor or medical facility providing treatment to confirm the policy coverage.
Conclusion
In summary, it is crucial to understand your health insurance policy’s waiting period, your insurance company’s requirements, and when the policy becomes effective. To ensure that there is no disruption in benefits and coverage, verify with your insurance company when the policy is active and when full benefits are available. Remember to check what is covered by your policy, the exceptions and restrictions in your insurance contract, and the healthcare services providers that accept your policy to maintain a smooth healthcare journey.
Common Questions and Answers
- Q: Does health insurance have a waiting period?
- A: Yes, some policies may have a waiting period of as long as three months before full benefits begin.
- Q: Can I start using health insurance as soon as I purchase it?
- A: After initiating the policy, you have immediate access to some benefits, but it is crucial to confirm with your insurance provider the activation date and when the policy begins providing full benefits.
- Q: Can I get medical care if I haven’t received my insurance card or confirmation of coverage?
- A: Contact your insurance provider to validate the policy, and they may send a temporary card or send a fax to the treating healthcare provider to confirm the policy coverage.
References
Types of Health Insurance: HMO, PPO, and POS Health Plans. (2013, January 23). WebMD. Retrieved from https://www.webmd.com/health-insurance/types-of-health-insurance-plans
Health Insurance. (2021, September 21). Healthcare.gov. Retrieved from https://www.healthcare.gov/glossary/health-insurance/
Health insurance. (2021, September 10). Investopedia. Retrieved from https://www.investopedia.com/terms/h/healthinsurance.asp