Have you ever tried to read your health insurance policy and feel like you are trying to understand a foreign language? There are few things more challenging than reading a health insurance policy cover to cover. In this blog we will tackle some of the most common terms found in major medical programs.
Co-pays – The amount the insured person will have to pay for services rendered by a healthcare provider. Co-pays are a common part of most insurance policies today and in many instances, it is not a small fee but can be substantial. It is important to understand your policy and the co-pay requirements to ensure you are maximizing your insurance without emptying out your wallet. Co-pays are a common expectation for prescriptions as well.
Deductibles – A deductible is the amount you as the policy holder must pay for health care services before the insurance will ‘kick in’. There may be full coverage that doesn’t require a deductible at all or deductibles can range in the thousands – depending on how much you (or perhaps your employer) pay for the policy. Once the deductible has been met you may still be required to contribute a nominal amount called a ‘copayment’.
In-Network & Out-of-Network – A physician or healthcare provider is ‘in-network’ if he or she has a contract with your health insurance company. Conversely, a physician or healthcare provider is ‘out-of-network’ if he or she does not contract with your health insurance provider. It is important to note that you are always able to work with any physician you want. But if the doctor is ‘out-of-network’ you will likely have to cover the cost of the services yourself.
Out of pocket costs – Expenses that are monetary direct payments. They may or may not eventually be reimbursed by the insurance company or third-party source. Most healthcare facilities will provide this information to you at the time of service and expect immediate payment under the circumstances.
Out-of-pocket maximums – The amount of payment you must make annually before your insurance will start to pick up 100% of the costs of your medical needs. It is important to note that this does not include your monthly premiums!