Choosing a personal medical insurance plan for you and your family:
Industry terminology, and a variety of plan designs can make choosing the right plan for you, and your family a complicated task. It is important to consider all of the plan benefits and coverage when making a plan choice. Several factors need to be considered e.g., plan deductible, pharmacy deductible, co-payments, and co-insurance, out of pocket maximum.
Choosing a plan without the help of a licensed, knowledgeable insurance agent may end up being an uninformed and costly decision. Remember, there is no fee to you for our services. Listed below is a summary of the more commonly used terms to help you in comparing healthcare plans.
Summary of the more commonly used terms when choosing an insurance plan:
- Allowed Amount: Maximum amount for which payment is based for covered health care services. This may also be called “eligible expense” or “negotiated rate.”
- Balance Billing: When a provider bills you for the difference between the provider’s charge and the allowed amount. For example, if the provider’s charge is $100 and the allowed amount is $70, the provider may bill for the remaining $30. A Preferred Provider may not balance bill you for covered services.
- Co-insurance: Your share of the costs of a covered health care service, calculated as a percent e.g., 20% of the allowed amount for the service. The health insurance plan pays the rest of the allowed amount.
- Co-payment: A fixed amount e.g., $30 that you pay for a covered health service, usually when you receive the service.
- Deductible: The amount you owe for health care services before your plan begins to pay. The deductible may not apply to all services.
- Maximum Out of Pocket Limit: The most you would pay during a policy period (usually a calendar year) before your plan begins to pay 100% of the allowed amount.
- Network: The facilities, providers and suppliers that your health insurance plan has contracted with to provide health care services.
- Pharmacy Deductible: A separate prescription deductible that needs to be met before the plan begins to pay for prescription drugs.
- Premium: The amount you pay for your health insurance plan.
- Primary Care Provider: A physician, nurse practitioner, clinical nurse specialist or physician assistant as allowed under state law, who helps a patient access a range of health services.
- Specialist: A physician specialist who focuses on a specific area of medicine to diagnose, manage, prevent or treat certain types of symptoms and conditions.
- UCR (Usual, Customary and Reasonable): The amount paid for a medical service in a geographic area based on what providers in the area usually charge for the same or similar medical service.
We are happy to help you decide which options are best for your and your family. Feel free to contact us here to schedule a free consultation.