How Insurance Impacts the Care You Receive

How Insurance Impacts the Care You Receive
January 7, 2021

No two health insurance policies are ever alike. In one way, this is great because the same applies to people. On the other side, because policies and how we use plans differ so much, it’s easy to find ourselves underinsured and in a spot where we don’t have enough coverage. The result is that the amount of coverage we have often reflects the care we receive. To learn how health insurance coverage levels impact the care we receive, read on.



No health insurance plan can promise a tinnitus cure. But for tinnitus patients, it sure helps to have great insurance to cover the care and treatment that goes with this condition. And for many who suffer from tinnitus symptoms or other nagging health issues, the level of coverage their health insurance policy offers means the difference between learning to live with it and treatment that works.

Healthcare in the United States is not created equal. For some, private plans or double coverage mean the best specialists and doctors out there. But for many, especially those on Medicare without advantage plans or supplemental insurance, it can mean minimal care and sometimes making hard choices between health care and putting food on the table.

As dramatic as it sounds, a person’s quality of life can depend on their medical coverage. While the Australian government, for example, sends people to public hospitals and provides citizens with coverage, being a private patient and a public patient aren’t the same either.

Whether you carry a Medicare card or the best in coverage, the level of effective treatment available to you, even from a general practitioner, might be different. For example, some doctors in the United States won’t even take on Medicaid or Medicare clients because reimbursement rates are not the same as they are for private pay patients. In a situation like this, the person with private insurance will obviously have better care than the person relying on the government-sponsored entitlement program.

Out-of-Network Coverage


Assuming you have insurance, whether it’s public, government-funded, or even private pay, you will still want to be very aware of what your health insurance will and won’t cover and income and coverage requirements like the medical levy surcharge in Australia. While America just eliminated the individual mandate, which was once a regulation as part of the Affordable Care Act. Whether you agree with these charges or not, they were put into place as a way to contain possible coverage gaps and defaults by patients who were underinsured.

Why do coverage gaps matter? For the same reason, your level of coverage does. Where there are gaps in coverage, there are gaps in care. That is, to receive the best in health care, it’s imperative that you understand your insurance company’s perks and clauses. For some people, their insurance won’t cover out-of-network doctors. This is an example of how coverage impacts care. Maybe you have hopes to see a well-known specialist for a disease that’s rare. If that specialist isn’t covered, you’ll be out of luck in attaining their health services.

Deductible Levels and Impact


For many, the quality of care depends on their policy’s deductibles and whether they can afford to go forward with treatments or medications without knowing the impact. That is, some people have to weigh the pros and cons of meeting those deductible caps before getting the care they need. For many, simply because of finances, they have to go without care or put themselves in hard situations to get the treatment recommended for them.

Prescription Coverage and Medications or Treatment


Prescription medication costs can be particularly hard. Where a brand name medication could put costs out of someone’s reach or at the very least, require a financial advisor to budget for, a generic or lesser medication might be affordable. This is a problem if you’re, for example, trying to beat a tumor but don’t have the coverage you need for another MRI or round of oral chemotherapy.

As unfair as it all may seem, medical expenses and the healthcare providers available to you are highly contingent on your health insurance coverage. Your plan can go as far as regulating the frequency of which you can see your treatment team. For this reason, it’s always smart to know your plan well and get the best you can afford to ensure the top care options and care should you need it.

Written By
Assistant Editor

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