This video addresses some of the ins and outs of health insurance. Just a disclaimer that this does not include everything and may not be specific to you and your plan in your area. Every plan will vary to see the differences, but this will give you a guide on what things mean and some guide on what to look for in your plan.
Here are a couple terms for you to understand before we get started. “Premium” – this is the $ amount that you pay to have the policy that you have. This is not an applicable number when going to your provider but is something to consider on your own. “Deductible” – this is the amount that you must pay, prior to the insurance helping you pay for your medical expenses. Sometimes this is an all-inclusive medical deductible and sometimes there are different deductibles for certain services. An expensive premium usually will make this deductible smaller and would be more recommended for those who are using their insurance more often. “Coinsurance” – this is usually a percentage that you would pay AFTER the deductible has been met. For example, let us say you have a 20% coinsurance for going into a medical practice and your deductible is $1000. You would have to pay $1000 prior to the insurance covering anything. After that deductible has been met, if the visit was $100, you would now only pay $20, and the insurance would pay the remaining $80. Typically, the coinsurance has to have the deductible met prior to paying anything. “Copay” – this is typically not concerned or subject to the deductible. For instance, it may be a $25 deductible to see a doctor or specialist and you would just pay that $25 each time whether you have met your deductible or not. Usually, copays are a flat fee per visit and coinsurance may vary depending on what is being performed by the provider.
When you are choosing a plan, look at those terms and see what you are comfortable with. Each plan may be better for certain people. For someone who is healthy and rarely uses their health insurance, you may want something that is going to have a high deductible, copay, and/or coinsurance, but it will be a lower premium. This would mean that you pay less unless something big happens, then the insurance will cover you. Sometimes you may hear of scenarios like this called a catastrophic plan. This means you are only planning to use this to help you if a major problem occurs. On the other side of this is if you are the person that is going to the hospital often and receiving a lot of care, the previously discussed plan would likely be a bad idea. This person would pay a higher premium in order to not have as much of the costs on each visit throughout the year. This is where you have to sometimes play the gambling game a little of what do you think you will need for coverage. Typically, January is when that deductible resets and you would start over on that number. If you spent $4999 of your $5000 deductible, by December 31st, the insurance has not paid any of your medical expenses, and then January 1st comes and then that number starts over.
Another common term would be “Out of pocket maximum” – this would be the amount that you can spend in the year and anything past that would be covered that is within your limits. Also look into the number of visits that are allowed. With chiropractic, sometimes insurance limits your visits to a certain number per year. Ask yourself how you want to use your coverage, but this will help you have a basic understanding of what to look for in your insurance plan.
Here is a link from Medicare themselves on more details.
Feel free to ask any more questions you may have and see you soon.
Tahoe’s Premiere Sports Chiropractor
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