Explore Costs
You want your insurance plan to cover your total health care costs as much as possible, you want affordable premiums, and you want any out-of-pocket health care costs to be minimal. To help you shop for an insurance plan that meets all of these factors, it’s important to understand the costs that go into buying and using health insurance. Here’s an explanation of some key areas.
Your Total Health Insurance Cost and the Participating Provider Network
When you choose an insurance plan, one thing to consider is the size of the participating provider network. A specific network of doctors, hospitals and other health care professionals, sometimes called providers, helps keep your premiums low for a number of reasons:
- Network doctors and hospitals have agreements with the insurance company that you save you money
- Services are provided at a lower rate to members
- Streamlined expenses, such as billing, keep costs down
- Providers are held to certain quality standards
When you choose care outside a specified network, benefits and costs can change. Every insurance plan is different, however, some plans provide limited coverage and others offer no coverage at all for out-of-network services. Since doctors, hospitals and other health care professionals outside the network don’t have an agreement with your insurance company, the price of services may be higher.
When you’re shopping for health insurance, look closely at the participating provider network. Check to see if you will be able to get as many services within the network as possible, or that you’ll have options, if you decide to go outside the network.
Other Expenses That Affect Your Total Health Insurance Cost
Your total health insurance cost can also be affected by your out-of-pocket expenses. There’s the copayment, which is usually a small fixed amount you pay per visit to in-network doctors. That’s not to be confused with coinsurance. That’s the percentage of costs you may be responsible for within your insurance plan, once you satisfy your deductible.
For example, let’s say you’ve met your annual deductible, so your benefits have kicked in. You may wonder what you will have to pay if you visit your doctor. The answer depends on the percentage your insurance plan pays for medical services that are covered under the insurance plan.
For example, you bruise your hip in a fall and you need an X-ray. Your insurance plan covers 80 percent of an X-ray. Here’s how the costs might break down:
- The X-ray costs $200
- Your annual deductible amount has been met
- Your insurance plan covers 80 percent, which is $160
- Your out-of-pocket cost, or coinsurance, is $40 for the X-ray
That’s a simple example. You should also be aware of the maximum limit for a procedure or medical service that may be specified in your insurance plan. These limits help keep rates to a fair and reasonable standard, which helps control costs for all members.
So, when calculating your out-of-pocket costs, two things to remember are the percentage that is covered in your insurance plan and the limit for any specific service you’ll be using. You also need to consider your out-of-pocket expense limits. The out-of-pocket expense limit represents the maximum amount you are responsible for each year. Once the out-of-pocket expense maximum is reached, insurance covers 100 percent of eligible expenses.
When you understand some of the costs of buying and using health insurance, it’s easier to find the insurance plan that’s best for you and your family. Best of all, you’ll be able to get the most out of the insurance plan you choose.
|
