The healthcare and health insurance world can be confusing! Whether this is the first year you're choosing a health insurance plan for yourself, or you've been in the game for awhile, knowing the basics is helpful.
I’ll be doing a series of articles here to give you some terms to know, basic information, and insight into what to consider while choosing a health insurance plan. The goal is for you to feel more confident in choosing the right health insurance plan. Also, I’ll share some tips and advice for how to get the most out of the insurance plan you have.
Today I’ll be showing you some basic information about how your benefits work. This is information that will help you understand how your benefits work, so you can then make a more educated choice for your health insurance based on your needs.
How Your Benefits Work
In-network vs. Out-of-network: An in-network doctor is someone who has agreed to a certain set of rates and a contract with the insurance company. Going out-of-network for care is significantly more expensive because that doctor hasn’t agreed to those same rates, and the health insurance coverage is significantly less to incentivize you to go in-network for care.
Co-pays, Deductible, Co-insurance, Out-of pocket max and how they all work together: The deductible for your plan is the amount that you must meet before the health insurance company starts to pay a portion. Co-pays are an exception to this; if your plan has co-pays, you have those at the start of your coverage. Once you meet the deductible during the year, you start paying the “coinsurance” or a percentage of the remaining costs until you hit the out-of-pocket maximum. Once you meet the out-of-pocket maximum, you will continue to pay your monthly premium, but you won’t pay any more in medical expenses in a year.
High deductible plans: A High Deductible Health Plan (HDHP) is a plan that is usually Health Savings Account qualified. This plan doesn’t have co-pays, so you’ll meet your deductible first and then pay co-insurance until your out-of-pocket maximum is met. Often, the deductible and out-of-pocket maximum amount are the same on this plan. A Health Savings Account (HSA) is an account you can open at your bank, and put money in tax-deductible when you have the compliant plan. The max you can put in is $3,450 for an individual and $6,900 for a family in 2018. This money always stays with you and you can use it an any time for medical, dental or vision expenses.