What do you mean by health insurance?
Health insurance involves an agreement between an insurance provider and an individual. In this arrangement, the insurance company must cover all or part of the individual's healthcare expenses in exchange for a monthly premium payment.
Typically, this agreement spans one year, during which the insured person is accountable for certain costs related to medical conditions, injuries, pregnancies, or preventive care services.
In the U.S., health insurance policies often include the following exceptions to coverage:
- Deductible: An amount the insured person must pay on their own for healthcare services before the insurance coverage begins.
- Co-payments: Fixed amounts the insured person must pay for specific medical services or procedures.
What are the different types of insurance plans?
When selecting a health insurance plan, you'll encounter terms like HMO, PPO, POS, and EPO. Understanding these acronyms and their differences is vital before you step into the capricious ocean of insurance plans and commit to an insurance carrier. Here's a comprehensive guide to help you get started:
Health maintenance organization (HMO) plan
HMO plans are known for their affordability, featuring lower premiums, deductibles, and often fixed copays. However, they only cover healthcare services provided by doctors and facilities within their network, meaning out-of-network benefits are unavailable. Additionally, you must obtain a referral from your primary care physician to see a specialist. This plan fits the bill for individuals who are typically healthy and want to keep their healthcare costs low.
Point-of-service (POS) plan
POS plans require you to pick an in-network primary care physician. This physician will coordinate your care and provide referrals for specialist services. Unlike HMO plans, POS plans offer some coverage for out-of-network services, albeit at higher costs. This plan is suitable for those managing a condition and needing the flexibility to see providers in and out of the network.
Exclusive provider organization (EPO) plan
EPO plans only cover in-network care but typically have a broader network of providers than HMO plans. Unlike HMO plans, most EPO plans do not require referrals to see specialists. The costs of EPO plans generally fall between those of HMO and PPO plans. This plan is an excellent middle-ground option for those who want more flexibility without the higher cost of a PPO plan.
Preferred provider organization (PPO) plan
PPO plans are the most comprehensive and expensive option. They offer extensive benefits, including coverage for both in-network and out-of-network services and the ability to see specialists without a referral. A PPO plan is the best choice if you need a high level of healthcare services and can afford higher premiums.
Insurance terms you should know
Before you visit a specialist, it can be helpful to understand the critical jargon related to health insurance. Here are some insurance terms you must know:
Guaranteed issue
This federal rule ensures you can sign up for any health insurance plan, regardless of your health condition, age, gender, or other personal factors. But in most states, this rule doesn't control how much insurance companies can charge you to enroll—unlike the Affordable Care Act, which has rules around pricing for people with preexisting conditions.
Grace period
It is the window of time you have to make a missed monthly premium payment before your coverage ends. If you pay before the grace period ends, your coverage stays active. But your insurance will be canceled if you don’t pay in time. That means you'll have coverage through the last month you paid for and be responsible for any medical costs you had after that.
Lifetime limit
This refers to a cap on how much your insurance will pay throughout your life. Like annual limits, it can be set as a total dollar amount, a limit per specific condition, or a limit on the number of certain procedures. Once you hit that lifetime cap, you'll have to pay out of pocket for any further healthcare services.
Out-of-pocket maximum/limit
This is the highest amount you'll have to pay in a plan year for covered medical services. Once you’ve paid enough in deductibles, copays, and coinsurance to hit that limit (note: this doesn’t include your premiums), your insurance will cover 100% of any additional covered costs. The federal government sets this limit and updates it each year.
For example, in 2019, an individual's out-of-pocket maximum for a marketplace plan was $7,900.
For more details about health insurance terms, look at Zocdoc's health insurance 101.
Introducing Aetna
Aetna is a global health insurance company and a subsidiary of CVS Health. Established in 1853 and headquartered in Hartford, CT, Aetna has nearly 170 years of experience in the industry.
The firm offers many insurance products and services, including Medicare, health, dental, vision, supplemental, pharmacy, and Medicaid coverage. It also covers healthcare management services, workers' compensation administration, and health information technology.
Aetna has a database of roughly 39 million people and a vast network of healthcare providers. So, for example, if you need an oral health checkup, finding an Aetna dentist near you is just a click away.
What are the signs you should visit a dentist immediately?
If it's been a while since your last dental visit, check for these signs as they may indicate that it's time you should see your dentist soon:
Tooth pain and inflammation in the mouth
Recurring pain or swelling in your teeth or gums can indicate infection or gum disease. Even if the pain subsides, the underlying issue may remain.
Bleeding gums
Healthy gums shouldn't bleed. Puffy, inflamed, discolored, receding gums, or gums with pus and odor can signal gum disease.
Recent dental work
Dental restorations like fillings, crowns, or implants can loosen over time. See your dentist to prevent further issues if they feel loose or uncomfortable.
Dry mouth
Constant dry mouth might indicate a medical condition. Saliva protects against decay, and your dentist can recommend ways to restore moisture.
Difficulty chewing or swallowing
Chewing or swallowing problems can lead to choking or aspiration. These issues can arise from dental problems or other medical conditions.
Persistent bad breath
Ongoing bad breath may indicate gum disease, diet issues, or other health conditions. Consult your dentist for personalized advice.
Lingering sores
Mouth sores lasting longer than a week can signal severe conditions like infections or cancer. Seek dental advice if you have persistent sores.
Jaw problems
Jaw pain or uneven bites can become severe if untreated. Causes include infections, arthritis, or teeth grinding. Your dentist can diagnose or refer you to a specialist.
If you notice any of these issues, it’s wise to search for an Aetna dentist near you who can address them promptly and is within your insurance network.
How to find the best dentist near you in Charlotte, NC?
If you need to consult a dental professional in your area, Zocdoc makes that search easy.
Visit the Zocdoc website or app, enter your symptoms, location, and insurance details, and browse a list of top-rated dentists. You can narrow your search by gender, availability, hospital affiliation, languages spoken, proximity, and whether they treat children.
To make an informed decision, review each dentist's educational background, clinical training, certifications, licenses, awards, and accreditations, and read genuine patient reviews.
Further, if you have an Aetna plan and want to see if the dentists in your area are in-network, input queries such as 'Aetna dentists near me' to get a thorough list. For assistance with insurance, you can upload a photo of your insurance card, and Zocdoc will help identify your plan securely and accurately.
When you book an appointment on Zocdoc, you must either provide your insurance details or confirm that you'll be paying out of pocket. Some providers require insurance information before you can schedule a meeting with them. If you don't have insurance or prefer not to use it, you can look for a different provider on Zocdoc. For more insurance information, visit Zocdoc’s insurance page.
Booking appointments with an Aetna dentist near you through Zocdoc is fast, free, and secure!
Statistics related to dental health and insurance in North Carolina
According to the United States Census Bureau, more people had access to health insurance in 2021 than in 2020. In 2021, around 8.3% of the population, or 27.2 million people, were uninsured at some point during the year, a decrease from 2020's approximate 8.6%, or around 28.3 million people.
Also, private health insurance remained more common than public coverage in 2021, with coverage rates of 66.0% and 35.7%, respectively.
Moreover, America's Health Rankings reported that 63.6% of adults in North Carolina visited a dentist in 2022. This number was lower than the national average, at 66%.
Sources
Investopedia
Aetna[1]
Aetna[2]
United States Census Bureau
Northgate Dental
America’s Health Rankings
Zocdoc
