What to Expect with Health Insurance

If you’ve never had health insurance before, you may have some questions about what to expect with your health insurance plan. Or maybe you have questions about how health insurance works even though you’ve had health insurance for a while. Understanding your health insurance plan can help ensure that you get the care you need without surprises.

What does health insurance pay for?

Most plans cover preventive health services, such as annual wellness visits and vaccinations. This also includes preventive screenings such as mammograms, blood work, and colonoscopies.

It’s important to take advantage of preventive health services covered by your insurance as they help keep you in good health. The idea behind preventive care is that you take measures to actively stay healthy rather than wait for a health problem to occur.

Some prescriptions may be covered under your plan while others aren’t. Your health insurance plan may cover the generic version of a drug rather than the name brand version of a drug, for example.

Most health insurers have a provider network, or a list of doctors and hospitals that your insurance provider has contracts with. You usually end up paying more if you visit a healthcare provider outside of your insurer’s provider network.

You generally have to pay something for emergency room visits under most health insurance plans. The amount that your insurer pays varies depending on whether or not you’ve met your deductible or out of pocket maximum. Urgent care centers can be a better choice for some insurance plans.

How much do you have to pay each month for health insurance?

You pay a monthly premium, regardless of whether you received medical care or not. Your premium does not count towards your deductible or out of pocket maximum. Monthly premiums vary from plan to plan.

The amount that you pay for health insurance doesn’t change during the year based on the medical care your receive. Medical bills are separate from health insurance. Your health insurer partially covers your medical expenses once you meet your deductible, and covers your medical expenses in full after you reach your out of pocket maximum.

What do you pay for after a medical visit?

You may pay for your all of your medical expenses until you meet your deductible, or you may have a lower co-pay for some care. Once you meet your deductible, your insurance company shares the cost of your medical expenses. Your deductible is the amount you pay before insurance helps covers the bill.

After reaching your deductible, your health insurance company pays a percentage of your medical expenses, and you pay the rest. For example, an insurer may pay 80% of your medical bill, while you pay 20%.

Once you meet your out of pocket maximum, your insurer pays usually pays 100% of anything over your out of pocket maximum for the remainder of the year.


It’s important to know the details of your health insurance plan. There are many different types of health insurance plans, and yours may be different than your friend’s or co-worker’s plan. Most plans offer free preventive care. Schedule your wellness visit with a MANA physician today!