Health Insurance FAQs

Any individual interested in purchasing health coverage for themselves or their family members must understand the basics how health insurance works.

What are the out-of-pocket fees?

The amount you can expect to pay for covered services each year is broken down as the premium, deductible, and any co-payments that apply. You may also be responsible for coinsurance up to the maximum of your out-of-pocket fees.

Fortunately for some, once the maximum out-of-pocket amount is reached for the year, the remainder of covered services should be completely paid for by the insurance company. The maximum for an individual is often an average of $1,000 while a family could expect to pay up to $11,000.

You must understand the deductible amount and percentage of coinsurance that is expected in addition to the upfront fees required to receive medical care. A lower monthly premium is typically in exchange for a higher deductible because you would essentially be paying a portion of the care cost upfront. Premiums must be paid regardless of receiving medical care, but deductibles come into play once medical expenses are actually incurred by the policyholder.

Choosing a Plan Can Be Simple

When it comes time to commit to a plan, there are a few factors to focus on. Consider the needs of yourself or your family members so that coverage will be adequate. Be sure that it comes at a reasonable cost in exchange for access and dependability. Evaluate each question below to be sure that your decision is a fairly easy conclusion.

Will a basic plan be enough for me, or does comprehensive coverage meet my needs better?

Basic coverage typically ensures that an unforeseen illness or injury that requires a hospital stay will not harm your finances. Expect that this minimum type of coverage will have a low monthly premium, but it will not cover regular doctor visits.

Comprehensive plans involve a greater amount of services that may include maternity benefits, prescription drug discounts, regular doctor visits, eye care, and health care. The premium for this coverage is much higher, but is the best value for any person that expects to use their insurance benefits regularly.

Does a health insurance plan include services from my personal doctor or preferred hospital?

Insurance plans come with a directory of providers so that the patient is able to stick with their own doctor when possible. It is important to check ahead of time to make sure that the network includes your doctor and local hospital if you want to avoid changing.

Am I still covered under a health insurance plan if I travel out of the area?

If you frequently travel out of the area for business or pleasure, you need to clarify the stipulations in terms of coverage. A plan may only cover you if you are within the network of providers, leaving you out in the cold should something happen when away from home.

Are all services that I need covered under a health insurance plan?

Plans differ from one another in terms of the types of coverage offered. Not all services that you want or need are guaranteed to be included so it is important to do the research and prioritize. For example, if you are an expecting mother or plan to start a family, you will need maternity coverage in combination with labor and delivery to get the most benefit.

Is my family covered by my health coverage?

There is a clear distinction between single coverage and coverage for the entire family, so be sure to clarify the type of policy you are committing to.

Does the plan I'm interested in offer a health savings account to help cover expenses?

Plans that feature a high deductible often work with health savings accounts to help pay for medical expenses that meet certain qualifications.

Will a health insurance plan cover any prescription drug prices?

The coverage for prescription medication expenses does vary from plan to plan, but typically require a co-payment to discount part of the cost. This is not a guarantee as other health insurance plans require that the policyholder meet the deductible if they want any type of coverage for prescriptions. It may be possible to consult a list of drugs covered by the plan if you are already on certain medications.

Ways You Can Save on Healthcare

The entire purpose of coverage is to cut down on overall cost, but becoming familiar with your healthcare options is the best way to save on those expenses.

Pick the Most Suitable Care Level

Understanding health care options and sticking with the most adequate helps maintain affordability by cutting down on costs.

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