The Affordable Care Act (ACA) identifies emergency care as one of the ten essential health benefits that health insurance plans must cover. Residents in New Windsor, NY, who don’t have ACA-compliant insurance may wonder if their health insurance policy covers emergencies. Fortunately, we have the answers you need.

Is Health Insurance Reliable in an Emergency?

Yes, health insurance is generally reliable in emergencies. Federal and state health insurance plans include coverage for emergency room care, and employer-sponsored and private health insurance plans typically follow suit.

Emergency care is defined as situations that are life-threatening or involve the potential loss of a limb without immediate medical attention. While definitions of emergency care may vary by provider, common qualifying emergencies include:

• Broken bones
• Seizures
• Stroke symptoms
• Shortness of breath
• Chest pain
• Heart attack
• Head trauma
• Severe injury
• Severe abdominal pain
• Severe burns
• Gunshot or stab wounds
• Uncontrollable bleeding
• Bites from poisonous animals

It’s important to understand your health insurance policy to ensure you’re prepared for emergencies. Knowing what your policy covers allows you to approach emergency situations with confidence that your provider will cover the necessary expenses.

Will Health Insurance Cover Everything?

No, health insurance does not cover all expenses. You’ll need to pay deductibles and copays before your insurance provider covers their portion. An agent at Kalare Tech can review your policy to explain the amounts or percentages for each. For coinsurance, your provider pays the majority, and you pay the remaining portion, which depends on the issue, hospital, and treatment options.

Additionally, some health insurance providers may impose time limits on coverage. For example, some policies cover you until your health stabilizes, while others provide coverage until you’re discharged from the hospital.

When time is of the essence, you can count on your health insurance to provide coverage. At Kalare Tech, we’re here to help you find health insurance that meets your needs and covers your expenses in an emergency. Contact our office for more information. We proudly serve the New Windsor, NY, area.

Understanding the type of care provided through your health care policy can be complex. All the different types of managed care have different rules, and you need to do different things to get services covered. At Kalare Tech in New Windsor, NY, we are independent insurance agents who work for our customers and will do our best to guide you through all the intricacies of managed care.

Health insurance policies offer three major types of managed care: HMO, PPO, and POS.

HMO

HMO stands for Health Maintenance Organization. This type of healthcare plan is the most restrictive. You will receive a list of participating healthcare providers that you can use. Your preferred doctor may or may not be on the list. You will need to choose a primary care physician who will coordinate your healthcare. You will need to get all healthcare within the network except in the case of an emergency.

PPO

PPO stands for Preferred Provider Organization. This type of managed care allows for a lot more flexibility. You pay the least if you remain in the network, but you can see any healthcare provider that you desire. You don’t need to get a referral to see a specialist.

POS

POS stands for Point of Service. It is not as restricted as an HMO but not as flexible as a PPO. It actually allows you to choose which one you want, HMO or PPO, on each occasion. However, you will need to get a referral to see a specialist, so you need to have a primary care physician.

Contact our dedicated team at Kalare Tech in New Windsor, NY, to help you understand your managed care options and choose the right coverage choice.