What is cost-sharing? Is my medication covered? Do I want a plan with a high deductible and low premium, or the other way around?
Insurance is as complicated as it is necessary, and it’s easy to feel overwhelmed by the number of choices. Where should you start to get the right coverage?
We’ve created an easy-to-follow list of health insurance essentials to help you figure out what you need from your health insurance. Consider making a corresponding numbered list so you can get your needs and your preferences organized before you start searching for insurance plans.
For more hands-on help, First Family Insurance has over 100 certified agents ready to take your call.
1. In-Network Providers
The term “in-network providers” refers to doctors or medical facilities that accept your health insurance. Every health insurance provider has a different network, so if you already have a family doctor, a clinic, or a pharmacy that you prefer, you should look for an insurance plan that includes them in its network.
Any money that you spend out-of-pocket at one of these facilities contributes toward your out-of-pocket maximum, which is the total amount you have to spend before your plan covers 100% of your medical costs. Out-of-network medical providers may not be covered at all, which could result in higher out-of-pocket costs for you. Out-of-network services typically don’t count towards your out-of-pocket maximum either, so these costs are entirely your own. Some out-of-pocket expenses could include specialist visits and certain prescriptions.
The overall cost of your plan can vary depending on a couple of factors.
Firstly, take a close look at each plan’s premium. This is the monthly cost of being covered by your insurance whether you use your benefits or not, so be sure this cost is within your budget or you could risk losing your insurance coverage.
Other costs associated with your plan are called cost-sharing, and this includes your deductible, your copays, and coinsurance. All three of these factors are considered out-of-pocket costs.
A deductible is an amount you pay out-of-pocket before your plan covers most expenses. Plans with high premiums typically have low deductibles and vice versa.
A copay is a flat fee that you pay every time you go to the doctor’s or fill a prescription. Your copay for each of these services is usually printed on your insurance card.
Coinsurance is a fixed percentage that you pay for services after you’ve satisfied your deductible. As an example, if your usual doctor’s visit costs for $100 and your coinsurance is 20%, then you would only pay $20 for the appointment after your deductible is covered.
The amount that each of these costs varies between plans, so educate yourself on how much the plan will practically cost to use. In general, if you’re a younger, healthy person who doesn’t need to see your doctor often, you might get more value out of a low-premium, high-deductible plan. If you have chronic health issues that require frequent trips to the doctor, a high-premium, low-deductible plan will likely be a better option for you.
INSURANCE TIP! Healthcare can be pricey, but government tax credits can help reduce the cost to you. This credit can be automatically sent to your insurance provider, which lowers your monthly premium, or you could receive a refund when you file your taxes.
3. Covered Medications
If you have medication that you’re already taking, make sure you find a plan that covers it. Each insurance provider has a formulary, or a list of medicines that are pre-approved for coverage.
Choosing a plan that covers your medication can help you avoid dealing with the lengthy process of obtaining coverage. This can involve additional paperwork on your part, and you might not know how much the insurance plan covers until they reimburse you.
Generally, generic medication costs less while brand-name medication is more than likely going to cost more. To avoid unnecessary costs, insurers may require patients to try lower-tier generic pharmaceuticals before authorizing them to purchase brand-name ones.
4. Health Savings Accounts (HSAs)
Some plans offer to set you up with a Health Savings Account, otherwise known as an HSA. HSAs are essentially specialized savings accounts that you can deposit money into for use on medical expenses. You own this account, not your insurance provider. It can be useful to ensure you always have the funds to pay for a medical emergency.
The biggest benefit to contributing to an HSA is that the money you deposit doesn’t get taxed. HSAs may also pay interest on your savings, which also isn’t taxed. The primary downside to consider is that if you remove money from the account for nonmedical reasons, you have to pay taxes on it.
5. Additional Perks
To sweeten the deal for patients, some insurance companies offer additional benefits for choosing them as a provider. These benefits could include free video conferences with your doctor and exceptional customer service, among others. These perks may not be essential, but they could make your insurance plan more convenient and useful.
If you feel overwhelmed, call an expert for help. We have 35 insurance brokers ready to take your call. Scheduling a consultation is quick and easy, and it might help you find a great deal where you only have to pay for the services that you need.
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