The value of health insurance for financial protection

The United States healthcare system consists of private and public insurers. However, private insurance is the country’s main form of health coverage. In 2019, about 92% of the population, or nearly 300 million U.S. citizens, had health insurance.

This figure suggests that many Americans, including professionals like EMTs, paramedics and firefighters, have health insurance coverage.

This article explains the importance of having health insurance for protecting your finances and includes the various services covered when you get health insurance.

Due to the nature of their jobs, EMTs and paramedics are at a high risk of exposure to infectious disease and injury, and firefighters are at risk of exposure to environmental hazards like asbestos, a compound that can cause health problems like cancer, including mesothelioma.

The Mesothelioma Group website contains information about the stages of mesothelioma, a rare cancer type.

Why health insurance is important for protecting first responder finances

Most people do not want to get sick or hurt, but they need medical care at some point in their lives. In this case, health insurance can cover the costs and provide many other benefits.

These needs can also apply to first responders. Although you provide emergency medical care to others, you are only human and not entirely immune to sickness or injury.

In other words, you can find yourself in similar situations as those you provide medical care to.

In general, health insurance can:

• Cover health benefits essential to maintaining your health, and treating accidents and illnesses
• Protect you from high and unexpected medical costs
• Let you pay less for covered healthcare even before you meet your deductible
• Give you free preventive care, like screenings, vaccines and check-ups, even before meeting your deductible

Depending on the sickness or injury, medical costs can get relatively high. The Centers for Medicare & Medicaid Services (CMS) provides the following estimates:

• A broken leg can require spending up to $7,500 to get fixed
• An average 3-day hospital stay can cost about $30,000
• Comprehensive cancer care can cost hundreds of thousands of dollars

The Bureau of Labor Statistics (BLS) states that the 2021 median pay for EMTs and paramedics was $36,930 and the 2021 median pay for firefighters was $50,700 per year.

When you compare this figure to the CMS cost estimates for medical care, this salary is barely enough to cover such expenses. And when you add the costs of your essentials like food, rent or a mortgage and utilities, you’ll begin to understand why many Americans opt to have health insurance.

When you have coverage, your plan can protect you from high medical expenses in the following ways:

• Decreased costs after meeting your deductible. An insurance plan’s deductible is the amount you pay yourself before your insurance starts paying.

  Your plan will cover some of your medical expenses when they reach the deductible amount. A marketplace plan can cover about 60% to 90% of your covered expenses after you’ve paid your deductible.

  For example, if your plan’s deductible is $2,000, you pay the first $2,000 for covered services.

  Afterward, your plan pays 60% to 90% of your covered medical expenses based on what insurance you have. This coverage means you’ll only need to shoulder 10% to 40% of the costs as copayment or coinsurance.

• Out-of-pocket maximum. You must pay this amount regardless of how much covered care your plan provides.

  Suppose your plan requires a $2,000 out-of-pocket maximum. This requirement means you must pay $2,000 in deductibles, copayments and coinsurance before your plan starts paying for any covered care within the year.

  Such a feature can protect you from high medical costs and give you relative peace of mind.

• No annual or lifetime limits. Health plans in the U.S. have no dollar limits on how much will be spent annually or over one’s lifetime for covering essential health benefits.

What does health insurance usually cover?

CMS requires health insurance plans offered in the marketplace to cover these 10 essential health benefits:

1. Ambulatory patient services or outpatient care
2. Prescription drugs
3. Emergency services
4. Laboratory services
5. Hospitalization, including surgery and overnight stays
6. Pregnancy, maternity and newborn care
7. Substance use disorder and mental health services, including behavioral health treatment that includes psychotherapy and counseling
8. Chronic disease management, and wellness and preventive services
9. Habilitative and rehabilitative services, and devices for helping people with disabilities, injuries or chronic conditions to gain or recover mental and physical skills
10. Pediatric services that include vision and oral care

These essential benefits are the minimum requirements for any health insurance plans offered in the marketplace. But each broad category can have specific services that vary depending on what a state requires.

This variation means plans can offer additional services like dental and vision coverage or medical management programs like weight management.

To learn more about health insurance or what coverage is appropriate for your needs as an EMT or paramedic, contact CMS at 1-800-318-2596 or visit www.healthcare.gov.