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The Ultimate Guide to Navigating Your Health Insurance Coverage

 

When it’s time to pick your healthcare coverage, there are a lot of elements to think about. Considering things like which insurance provider you need, which plan you need, and how you’re going to pay for it all are important aspects to think of.

 

Here are some of our most-asked questions when it comes to shopping for health insurance. 

What Coverage Do I Need?

 

Your healthcare benefits will cover a portion, or all of your medical expenses. Depending on your needs as an individual, your plan and the type of coverage you need will change. Start by asking yourself:

  1. How many dependents/family members need to be covered
  2. How frequently you or your dependents seek healthcare services
  3. If your employer offers a employee health benefits and what they cover
  4. If you qualify for Medicare, Medicaid, or CHIP 
  5. If you or your dependents have pre-existing, on-going, chronic, or extensive medical conditions
  6. How many medical conditions you have
  7. If you require additional services like a chiropractor

 

Health insurance doesn’t just cover doctor’s visits for you and your family. Health insurance also covers things like prescription drugs, dental care, vision care, and specialist visits. However, it can be expensive, so it’s important to prioritize what needs to be covered. Your coverage can also change depending on what network you’re in, and the premiums and deductibles you get with your plan.  

What’s a Network?

 

Insurance providers will have contracts with certain networks of healthcare professionals. Their agreements will normally allow them to set lower rates when you access care. A network under your insurance provider can include:

  • Doctors
  • Clinics
  • Hospitals
  • Primary care providers
  • Specialist 
  • Other healthcare professionals

 

Be sure to check with your doctor to see what networks they work with. 

What’s a Premium?

 

A premium is the monthly payment for your insurance provider. This amount will go towards your medical expenses. The higher the premium, the less you have to pay up-front. To keep your health insurance active, you need to pay this amount every month. Depending on the type of coverage you have, it can change. 

What’s a Deductible?

 

A deductible is the amount you pay yearly, and it goes towards your medical expenses. Let’s say you have a $1000 deductible. That money will go towards your medical bills, and your insurance provider will pay the rest of any other bills you have. 

What Payment Plans Are There?

 

Health insurance can be expensive, but there are ways to make payments toward your medical care easier like coinsurance or a health savings account.

What is Coinsurance?

 

Coinsurance is the shared amount you pay with your insurance company, and is different from copay. Let’s say you have a prescription that’s $100, your coinsurance plan will pay for 80 percent of the prescription, while you pay the other 20 percent. This means that if the price in the prescription goes up or down, you will always pay 20% for the prescription. 

What is Copay?

 

Copay is the set amount you pay for doctor’s visits and prescriptions. Let’s say you have a prescription that costs $100. Copay allows you to only pay for $20 every time you refill that prescription, while your insurance pays the rest. The amount of coverage can change depending on the type of plan you have.  

What is a Health Savings Account (HSA)?

 

An HSA is the account where you can set aside tax-free money to use towards any healthcare expenses. This money can be used for your coinsurance and copay. Even if this money goes unused, it’s yours to keep at the end of the year.

What is a Health Reimbursement Account (HRA)?

An HRA is similar to an HSA, but the account belongs to your employer. Check with your employer to see if this money can be used to go towards your coinsurance and copay. Your employer can help you pay for any healthcare expenses you may have, but any leftover money belongs to your employer at the end of the year. 

What’s a Flexible Spending Account (FSA)?

An FSA is an account that will allow you to set aside money for medical costs, child care, and other health services. Check with your employer to see if this money can be used to go towards your coinsurance and copay. Most FSA’s will lose any remaining money at the end of the year.  

What if I can’t afford Health Insurance?

There are some government-funded programs like Medicaid and Medicare. Check out our page on comparing health insurance to see if you might qualify for one of these programs.

What Types of Plans Are There?

There’s a few things you need to consider with your health insurance like the coverage you’ll need. They’re different and uniquely built for your needs. Here are some of the most common plans out there.

What’s a Health Maintenance Organization (HMO)?

Health Maintenance Organization (HMO) will cost less up-front. With this plan, insurance doesn’t normally cover care outside of its network. These plans normally also have a co-pay that must be paid when you access care instead of a deductible. 

What’s a Preferred Provider (PPO)?

Preferred Provider (PPO) offers flexible coverage inside and outside its network. However, insurance will cover less if you go outside of your network. These plans have higher out-of-pocket costs.  

What’s a High Deductible Health Plan (HDHP)?

A High Deductible Health Plan (HDHP) is a type of Consumer Directed Health Plan (CDHP). They’re great if you don’t require regular doctor visits, or access to healthcare. They have a higher deductible, which means you have a lower monthly premium. There is normally a set deductible amount for this type of plan.

What’s a Point of Service (POS)?

Point of Service (POS) plans are a combination of HMO and PPO plans, as they help manage care with your regular doctor within the network, but will also for flexibility outside the network. These plans don’t require you to reach your deductible amount at the time of service, but will require a co-pay.  

What’s an Exclusive Provider Organization (EPO)?

Exclusive Provider Organization (EPO) does not cover care outside its network, similarly to HMO. These are affordable plans that allow you to seek specialists without a referral from your regular doctor.
It’s important to know all these terms when figuring out what health insurance will be best to cover you. Feel free to talk to us at (877) 200-6113 if you have questions, or want to know what you can do with your health insurance.

 

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