Comparing healthcare plans can be overwhelming, especially when you’re not familiar with the healthcare terminology and phrases that can help you make the right decision. When it comes to choosing the right insurance, it helps to know exactly what you’re getting into by learning more about the common terms and phrases used surrounding healthcare coverage. Here are five health insurance topics easily explained.
1. Premium
A premium is the monthly amount you’ll pay to a health insurance company in exchange for health insurance coverage. The premium varies from plan to plan and oftentimes depends on the amount of coverage you need. The less you pay for coverage, the more likely it is you’ll have to pay when you need healthcare services. Usually, premiums have a due date and a grace period. As long as you pay before or during the grace period, you’ll remain covered.
2. Co-pay and Coinsurance
A copay is a fixed amount you’ll pay for certain services. Every time you see a medical care provider or get dental solutions at Rock Rose Dental In Roseville, you’ll have to pay your copay before you can see the doctor. Copays can range from $0 to $100.
Coinsurance is a fixed percentage (such as 15 percent) of the price of each medical service you receive. The remaining percentage is covered by your health insurance company.
3. In-Network
When someone says “in-network,” they’re referring to the providers or healthcare facilities that make up a health plan’s network of providers. You’ll always pay less when you stay in-network, meaning you choose providers from the list of in-network providers, specialists, and healthcare facilities. If you go out-of-network, you’ll usually have to pay more for services. Whether you’re allowed to go out-of-network will depend on what type of healthcare insurance plan you choose (HMO or PPO).
4. Deductible
A deductible is the amount you’ll pay for health care services before your insurance company has to start paying. Let’s say you have a $1,000 deductible. You’ll pay $1,000 before it’s the insurance company’s turn to start paying. Once you pay your deductible, you’ll typically have to pay only a copayment or coinsurance prior to getting medical services. Then, it’s up to your insurance company to pay the rest.
5. Out-of-Pocket Costs/Maximum
Your out-of-pocket expenses are the costs you’ll pay from your own cash reserves. Out-of-pocket healthcare expenses might include prescription drugs, medical services, and medical supplies (such as contact lenses or glasses). The amount of out-of-pocket costs you’ll have will depend on what type of plan you choose and your provider.
Types of Coverage & Things to Consider
There are several types of health insurance plans to choose from, including HMOs and PPOs. If you’re going to be enrolling in Medicare, doing a Medicare Advantage plan comparison can help you decide which plan is right for you.
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Some of the factors to consider when enrolling in coverage include whether you need prescription drug coverage, whether you prefer an HMO or a PPO, and what you’ll pay out of pocket.
An HMO (Health Maintenance Organization) is a type of healthcare plan that allows you to choose only from a specific list of doctors and healthcare facilities in the network. If you need a specialist, you’ll need a referral from your primary care doctor.
A PPO (Preferred Provider Organization) is a type of health plan coverage that covers services from almost any doctor or hospital. This type of plan allows you to go out-of-network, but you’ll have to pay extra to do so. With a PPO, you don’t usually need a referral from your primary care doctor.
Comparing Different Healthcare Plans
By gaining a better understanding of health insurance topics, you’ll be more prepared to enroll in a health insurance plan that suits your needs. Think about whether you need prescription drug coverage, how much you’ll have to pay out-of-pocket, and whether you prefer a PPO or HMO. With the above in mind, you should feel confident knowing you’re making the right decisions when it comes to comparing different healthcare plans.
