Need to Know Health Insurance Basics

BY FIRST FAMILY INSURANCE May 11, 2020
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Health Insurance can be intimidating and overwhelming, but in the worst-case scenario, it can protect you from high costs in an emergency room visit.

 

Below are the critical things you need to know.

 

Premiums

This is your monthly payment for access to the health insurance plan. This monthly payment is different from your overall costs for health care services. For instance, if you have a high premium, you ‘ll end up paying less out of pocket when visiting your doctor and vice versa.

 

Deductible

A deductible is the amount you’ll pay for covered services before your insurance kicks in. Keep in mind that even after meeting your deductible, you’ll still have copays and coinsurance to pay. The deductible is different from your out-of-pocket maximum, which we’ll get to as you read on.

 

Copayment

Known as copay, is the fixed amount you’ll pay for a covered service or prescription medication set by the insurance plan. This fee gets applied to your out of pocket maximum.

 

Coinsurance

Much like copayments, coinsurance is another way costs get split between the insurer and the insured. However, coinsurance is not a fixed amount, it is a percentage of the cost you will pay for a covered service. For example, if you have a 20% coinsurance, you’d pay 20% of the total cost of the covered service until the out-of-pocket maximum is met.

 

Out-of-pocket Maximum

The out-of-pocket maximum is the most you will have to pay out of pocket for covered health services in a year. This maximum includes deductibles, copay, and coinsurance. Monthly premiums do not count for the out-of-pocket maximum. 

 

Health Plans can also differ in the type of network they are participating in and which doctors are in each system.

 

Our licensed professionals are here to assist you with questions or concerns about your current health plans. 

 

Call today 1-800-327-5579, or have an agent reach out to you by clicking the link below.

 

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