Health Insurance Plans 101

Just because a father’s role is to provide and protect doesn’t mean he can’t get some assistance in doing so. When it comes to protecting yours and your children’s health, health insurance can be a life saver. There are a few things you should know about when shopping for that almighty health insurance armor.

Are All Plans the Same?
No, health insurance plans vary drastically. Each plan offers different coverage for different rates. Some plans cover specific areas that might not be where you live. Other plans may cover in your area, but only for a select number of doctors. Make sure you check with the sales representative to find coverage that suits your area and choice of physicians and facilities.

What Does All the Mumble Jumble Mean?
There are a few terms you need to know about when it comes to health insurance coverage:
Premium: what you pay monthly to have the privilege of health insurance
Copay: A set fee you pay to see a doctor, specialist or facility
Coinsurance: A percentage you are responsible for after your insurance has paid their portion. An example would be 80/20, you pay 20% of allowable after insurance pays 80% of allowable
Deductible: A set amount you are responsible to cover before your insurance pays anything
Pre-existing: Insurance can opt to not cover treatment for specific illnesses. These are illnesses you had before your insurance began. This will only last for a predetermined amount of time.
Contract Providers: Doctors or companies that accept your insurance. Contracted providers usually accept lower rates and offer discounts for your insurance company. Thus reducing your out of pocket coinsurance amount
Out of Pocket Maximum: This is the maximum amount, usually does not include copays, you are responsible for in a year. After the Out of Pocket Maximum is reached, insurance typically picks up at 100%

How Do Pharmacy Benefits Work?
Your insurance plan should offer pharmacy benefits. There will be multiple tiers. These tiers are assigned different monetary values. More common drugs cost less out of pocket, while other drugs can be quite costly. Usually when you go to the pharmacy, you will pay a copay based on the tier in which the drug comes from. If a drug is too costly or isn’t covered by your plan, your pharmacist can work with your doctor to see if another drug can be substituted.

How Do I Know if I Have Good Coverage?
Coverage varies from plan to plan. The less you have to pay out of pocket the better. You will ultimately have to find a balance between what you pay in premium and what you payout of pocket to see the doctor. The lower your deductible, the higher premium you can expect to pay. You want the lowest deductible, lowest coinsurance and lowest copays while being able to afford your premium.

Will My Doctor Accept My Insurance?
If you are not keen on changing doctors, you will need to call your doctor to see if they take your insurance. Some physicians may not be contracted, but may offer to bill your insurance for you. Also, call the insurance company and request a list of providers.

What Else Can An Insurance Company Do For Me?
Some insurance companies offer perks to their members. These perks can be discounts on travel, emergency roadside assistance and discount to various clubs and stores. Some companies also have online sites that have a number of choice options. These can be links to healthy tips, relaxation programs and medical tips. Nurse hotlines are another great perk. This provides access to speak to a nurse 24 hours a day, 7 days a week. The nurse can provide tips or recommend you seek further medical attention.

There is a lot of items to consider when sorting through health insurance plans. You need to make sure you can afford your premiums, as well as, the out of pocket costs. By weighing your options like cost versus benefits, you can make the best choice that is right for you and your family.