Health Insurance Basics
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.
Deductible is important basic knowledge when it comes to health insurance. The lower your deductible amount the more you can expect to pay in premium. The deductible must be met by the consumer before the insurance company agrees to share the cost.
After meeting your set deductible you may the start paying a percentage of your occurred medical expenses. This is what insurance companies refer to as co insurance. You may have a 70/30 plan with a maximum of $2000. So the insurer would cover 70% while you cover 30% until the maximum was met, at which time the insurer would pay 100% for the remainder of the year.
Another often misunderstood part of insurance is Co Pays. If your plan has built in Co pays for Office Visits you pay only the co pay amount even if you have not met your deductible or co insurance. There are some exceptions, if not noted in the plan as included in office visit you would still have to pay lab and x-rays.
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.
Each plan has limits set forth by the carrier/insurer/insurance company as well. Some examples of limits are: You are only allowed a specific number of office visits. You are allowed a certain dollar amount on things such as prescription benefits, labs, mental health and emergency visits. These are important to pay attention to when choosing and comparing plans.
Another item that is specific is Prescription/RX/Medication coverage. Some plans have a Co pay depending on they type of prescription. Some only offer discounts and some cover absolutely nothing. Many plans also have limits to the amount they will pay per year as noted in #6.
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Written by Jeff Cline on December 10th, 2009 with
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