Understanding the Basics of Healthcare Insurance

Trying to find the best healthcare insurance plan for you and your family is not always easy. There are many things to consider and you really don’t know what type of medical costs you are likely to incur in later years.

With the new changes to healthcare in the United States there are now 10 basic or essential benefits that every healthcare plan must cover.

  1. Emergency services
  2. Hospitalization
  3. Laboratory tests
  4. Maternity and newborn care
  5. Mental health and substance-abuse treatment
  6. Outpatient care
  7. Pediatric services including dental and vision care
  8. Prescription drugs
  9. Preventive services (such as immunizations and mammograms) and management of chronic diseases such as diabetes
  10. Rehabilitation services

There are currently two basic ways that you can pay for your health insurance plan. You pay a monthly premium when you sign up for your new plan. Then you pay a certain percentage or share of the expenses you incur, these are referred to as out of pocket expenses. In addition there are some combinations of this basic idea, depending upon the insurance company.

One thing to remember is that if you pay a higher monthly premium, your out of pocket expenses will be less. Some State’s also have subsidies that you may qualify for.¬†When it comes to subsides there are standardized plans that can be used to help you compare the different plans.

A Bronze plan covers approximately 60% of the member’s total health care costs so will have a lower premium. Silver plans cover around 70% and Gold plans cover 80%. The highest coverage is the Platinum plan with 90% coverage. But this will also have the highest monthly premium.

Knowing which plan to choose will depend upon your current health status and your income level. If you have an existing medical condition then a higher premium plan may be your best choice.

If you are currently in good health then choosing a lower premium plan may be the best alternative for you. Remember if you choose this option if you do become sick you will then have to pay out more money.

Not sure what your out of pocket expenses will be? This can be confusing for lots of people, and could be a huge cost if you are not prepared. When most health insurance plans talk about out of pocket expenses they are talking about the parts of your medical bills that you will have to cover. This does not include your monthly premiums.

Most plans have a deductible – this is the amount that you are responsible for first. If your deductible is $1,000 you must cover this amount first, then the insurance company would start paying.

Copay – this is where you pay a fixed fee for certain things and then the insurance covers the remainder.

Coinsurance – this is where you pay a certain percentage for certain costs such as an MRI and then the insurance pays the rest.

Out of pocket limit – once you hit this amount your healthcare plan will cover the rest of your bills. This normally only happens if you are in a serious accident or suddenly become seriously ill.

Always check all the details of each plan and check with your doctor that they are in fact registered with this company. If not your expenses may not be covered at all. Plus if you know you are looking for some specific coverage then ask about these costs, especially if they are concerning cosmetic surgeries.