What Does Basic Health Insurance Cover?

    What Does Basic Health Insurance Cover?

    Taking care of one’s health is of utmost importance, so once a person’s health is jeopardized or has met an unexpected accident, that would surely cost a lot. This is where health insurance comes in, health insurance is a plan that most families and individuals usually pay for.

    Health insurance provides medical benefits such as essential health benefits, protection from high medical bills, preventive care which includes vaccines, check-ups, and the like, and paying less for covered health care even before reaching the deductible.

    What Does Basic Health Insurance Cover?

    These plans cover the following essential health benefits:

    • Doctor’s services
    • Prescription drug coverage
    • Pregnancy and childbirth
    • Inpatient and outpatient hospital care
    • Mental health services
    • Emergency services
    • Laboratory services
    • Preventive and wellness services
    • Pediatric services (oral and vision care)
    • Rehabilitative and habilitative services (helps people with injuries, chronic conditions, disabilities, and recovery from mental and physical skills)

    There are also additional benefits for certain plans as well. Such benefits would include:

    • Birth control coverage
    • Breastfeeding coverage
    • Dental coverage
    • Vision coverage
    • Medical management programs

    These are some of the essential health benefits that health insurances cover. Do take note that there are varying plans that cover more services as well. This would be provided to an individual or to families who are paying for either a private plan or a plan that they have gotten through their employer.

    The said plan would come with a standard form called the Summary of Benefits and Coverage. With this, families and individuals would find it easier to compare costs and benefits with other insurance plans as well.

    How Much Does Health Insurance Cost?

    The cost of annual premiums is $7,470 for individual coverage and $21,342 for family coverage, these are health insurance costs in 2020.

    On average, annual health insurance for individual coverage in small firms is similar to that of large firms ($7,483 for small firms and $7,466 for large firms). On the other hand, family coverage for small firms is smaller compared to family coverage in large firms ($20,438 for small firms and $21,619 for large firms).

    Of course, these costs are just an average of how much people spend on their health insurance, moreover, said costs are not classified under a specific health insurance plan.

    Health insurance plans would each have varying costs and this is where people should acquaint themselves with the term premium. Premium refers to the fee that people have to pay to get and keep their own health insurance.

    People may choose to pay for the entire premium or half of it. It is common for employers to pay for half of the premium as well. Then there are individual or family coverages that the federal government would pay for if they qualify for the premium subsidy (e.g. if you buy a premium through Covered California).

    The payment for premiums usually happens every month, but of course, the frequency of payments and cost of the health insurance would vary per person. For instance, age would be a factor, children would have more benefits compared to adults (e.g. dental and vision coverage), the location of where a person lives, cost-sharing, and the number of family members included in the coverage are all factors to the total cost of a health insurance.

    Common Health Insurance Offerings and Coverage

    There are three types of plans that are usually being offered, namely, these are indemnity plans, managed care plans, and consumer-driven plans.

    Indemnity plan

    A person with this plan would pay for a doctor directly, show their insurance, and then receive half of the total cost from the insurance company. This type of plan does not include preventive care (e.g. annual physical exams).

    Managed care plan

    This type of insurance is usually given by an employer. Managed health care plans would include the following: HMO, PPO, POS, and EPO.

    Consumer-driven plan

    This type of plan grants a person the chance to control where their money goes when it comes to their health care cost. The downside of this would be the deductible’s high price.


    Health insurance is an important benefit for both individuals and families because this would help them save a lot of money in terms of medical bills in the long run. Also, this would ultimately give them a better life since various health benefits are part of a health insurance plan.

    Learn more about General Health Topics here.

    Hello Health Group does not provide medical advice, diagnosis or treatment.

    Fact-checked by

    Kristel Lagorza

    Written by Jen Mallari · Updated Oct 22, 2021