Educating yourself on the ins and outs of health insurance is essential to understanding it. Many people find the details to be confusing to say the least. If you stick to these 7 basics you will succeed in understanding health insurance. This will allow you to make wise decisions and educated choices while finding individual health insurance.
When going down the list of basics naturally the total amount the insurance carrier will pay is a huge factor. This is what they call the Lifetime Maximum. It simply means that they will never exceed that amount if you should reach it. On average they are $3-$5million. When thinking in terms of a major critical illness that can easily cost millions, this amount could be your deciding factor.
Deductibles also make a significant difference. The deductible is the amount you must pay out of pocket before the insurer will share any cost. A general rule is the higher the deductible the lower the premium will be. When you hear the term "Total out Of Pocket' it is referring to your deductible plus your co insurance.
Once the deductible is met you may have Co-Insurance. This is when the insurer begins sharing the cost. Typically the split is 80/20, 75/25 or 50/50, depending on your plan. There is a limit on the co insurance as well. For example, Johnny has an inpatient hospitalization for an injury. Johnny has met his $2000 deductible already and he has 80/20 co insurance up to $3000. So Johnny would pay 20% of his total bill not to exceed $3000 out of his pocket.
I am sure you have heard people say I only pay $25 when I go for an office visit. What they are referring to is the plans office visit co pay. Co pays are simple really for the life time of your term if you should have an office visit you can expect to only pay that predetermined amount. The only exception is if the plan states that labs and x-ray in an office visit is not covered.
Some plans include a Preventative benefit. The will allow 1 preventative exam each year. Many consumers do not understand this benefit fully. The main thing is it often has a maximum payout. For example, insurer will pay up to $300 of the visit. Not all plans include this benefit and they do not all cover a broad range of screenings and such. So it is important to comb over the details before you go for this kind of visit.
One basic that is detailed in clear is the limitations. These are sometimes overwhelming to consumers and overlooked. But you need to take the time to know the limitations. They may restrict how much the pay for certain illnesses or treatments. They may only pay for 2 office visits a year.
Getting your prescriptions covered is important to many due to the high cost of prescriptions. So knowing how your prescription coverage works is very important. One plan may cover a generic at one co pay and a brand name at another. You might also have a cap. For instance the carrier may only agree to pay $500 a year in Brand name.
When going down the list of basics naturally the total amount the insurance carrier will pay is a huge factor. This is what they call the Lifetime Maximum. It simply means that they will never exceed that amount if you should reach it. On average they are $3-$5million. When thinking in terms of a major critical illness that can easily cost millions, this amount could be your deciding factor.
Deductibles also make a significant difference. The deductible is the amount you must pay out of pocket before the insurer will share any cost. A general rule is the higher the deductible the lower the premium will be. When you hear the term "Total out Of Pocket' it is referring to your deductible plus your co insurance.
Once the deductible is met you may have Co-Insurance. This is when the insurer begins sharing the cost. Typically the split is 80/20, 75/25 or 50/50, depending on your plan. There is a limit on the co insurance as well. For example, Johnny has an inpatient hospitalization for an injury. Johnny has met his $2000 deductible already and he has 80/20 co insurance up to $3000. So Johnny would pay 20% of his total bill not to exceed $3000 out of his pocket.
I am sure you have heard people say I only pay $25 when I go for an office visit. What they are referring to is the plans office visit co pay. Co pays are simple really for the life time of your term if you should have an office visit you can expect to only pay that predetermined amount. The only exception is if the plan states that labs and x-ray in an office visit is not covered.
Some plans include a Preventative benefit. The will allow 1 preventative exam each year. Many consumers do not understand this benefit fully. The main thing is it often has a maximum payout. For example, insurer will pay up to $300 of the visit. Not all plans include this benefit and they do not all cover a broad range of screenings and such. So it is important to comb over the details before you go for this kind of visit.
One basic that is detailed in clear is the limitations. These are sometimes overwhelming to consumers and overlooked. But you need to take the time to know the limitations. They may restrict how much the pay for certain illnesses or treatments. They may only pay for 2 office visits a year.
Getting your prescriptions covered is important to many due to the high cost of prescriptions. So knowing how your prescription coverage works is very important. One plan may cover a generic at one co pay and a brand name at another. You might also have a cap. For instance the carrier may only agree to pay $500 a year in Brand name.
About the Author:
For fantastic service Agent Jeff Cline is ready to assist you with your individual health insurance needs. Agent Jeff Cline will assist you with all health insurance needs, even travel medical insurance for your exciting trips you have planned. Call us 7 days a week. Our toll free number is 866.526.9669
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