Health Insurance 101
Two weeks ago, we introduced the problems that occur when insurance gets involved in paying for routine care and how that drives up prices.
Last week, we discussed how you can supplement HELPcare Clinic membership with insurance or other healthcare cost sharing programs to cover an emergency or other unforeseen health event i.e what insurance is supposed to be.
Today, if you are among the many who will be choosing between health insurance plans in the coming weeks, we want to provide you with a primer on some of the terms that you'll be encountering when deciding between different health insurance options.
Networks—Insurance companies set up programs in which hospitals and providers agree to a schedule of reduced fees for various services to be considered “in network” for the company’s policyholders. If you get care outside of the network, you will pay more for covered services. Or, depending on the policy provisions, you may not be reimbursed for out-of-network care at all.
Deductible—This is an annual amount you are responsible for before any insurance payments kick in. For example, you may be responsible to pay the first $1,000 or $5,000 for covered services during a calendar year. The higher your deductible, the lower your monthly premiums will be, because the insurance company doesn’t have as much risk. While insurance plans cover preventive services, the lab tests you may have during an annual exam are classified as diagnostic and would be your responsibility if you haven’t yet satisfied your deductible.
Coinsurance—The percentage you pay after you have satisfied your deductible obligation. Insurance policies have widely different coinsurance percentages. A Copay is a flat fee you pay for certain services.
Out-of-Pocket Maximum—The most you would pay for covered services in a calendar year. As with the deductible, if you accept a policy with a higher out-of-pocket maximum, your premiums will be lower.
When you’re choosing from among your health insurance options, take these factors into account along with the monthly premium.
To find out more about how you can restore health insurance to its proper role, request a free copy of our informational booklet, Saving Through Membership today.
Update (10/27/22 - 11:53 a.m.) - Lee Aase discussed this with Jason Brandt this morning on KAUS 1480:
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