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Understanding Health Insurance in new york city

Health insurance is one of the most important investments anyone can make in their own and their family’s health and well-being. It is critical to understand how the health insurance system operates, what health insurance helps to pay for (and how much of the expense is covered), where you can get services from, and how to get the best out of the system. Getting help with health insurance in New York (and the US in general) can be difficult, as insurance company representatives are often unwilling, unable, or not permitted to answer specific questions; meanwhile, policy documents can be long and confusing. This is why understanding broadly how the system works, what specific terms mean (such as premium, deductible, co-pay, out-of-pocket maximum, in-network / out-of-network, etc.), and what to look out for is so vital.

What Is  A Health Insurance Deductible?


A health insurance deductible can be thought of as the total amount the patient (insured person) must pay themselves for medical services, before health insurance starts to pay. The deductible differs based on the individual plan, whether the health insurance coverage is for an individual, couple, or family, and the level of premiums paid for insurance coverage. Generally speaking, a lower deductible health insurance plan costs more (i.e. has higher premiums) than a high deductible plan, and vice versa. Other than the premiums paid for having insurance coverage in the first place, the deductible is usually the biggest cost of using health insurance.

Health Insurance

What Does Health Insurance Help Pay For?

Health insurance provides protection against certain costs associated with getting sick. Consumers pay an amount (usually monthly or bi-weekly) to obtain coverage, and in exchange, health insurance provides a promise to cover certain expenses in the event of illness.

The Affordable Care Act

The Affordable Care Act requires (as a minimum) all health insurance plans to provide the following 10 essential health services:

1. Ambulatory patient services (outpatient care that you can receive without being admitted to a hospital);

2. Emergency services;

3. Hospitalization for surgery, overnight stays, and other conditions;

4. Pregnancy, maternity, and newborn care;

5. Mental health and substance use disorder services;

6. Prescription drugs;

7. Rehabilitative and habilitative services and devices (treatment and devices that help people gain or recover mental and physical skills after an injury, disability, or onset of a chronic condition);

8. Laboratory services;

9. Preventive and wellness services, as well as chronic disease management; and 

10. Pediatric services, including dental and vision coverage for children.

Eye and dental procedures for adults may or may not be covered, depending on the state of residence of the insured, and the individual policy. Most health insurance does not cover cosmetic procedures, fertility treatments, or treatments that are new or not approved by the Food and Drug Administration.



Deciding whether to have health insurance, who should be covered, what level of coverage or plan should be selected etc. can be a difficult, time-consuming, and stressful process. This is where Life Streamliner can help; by summarizing your options, the pros and cons of each option, explaining what factors to consider (and why), and recommending a course of action, Life Streamliner will simplify the process of protecting you and your loved ones. By providing clear and easily understandable explanations of confusing terms and concepts, Life Streamliner will equip you with the knowledge and skills necessary to make an informed decision. In addition, the knowledge and skills gained will not only continue to guide you in all insurance-related matters in the future but also in many other aspects of your day-to-day life.

Already know what you need? Schedule your FREE consultation!