Friday, January 23, 2009

Knowing the Basics of Health Insurance

By Jeff Cline

Educating yourself on the ins and outs of health insurance is essential to understanding it. Many people find the details to be confusing to say the least. If you stick to these 7 basics you will succeed in understanding health insurance. This will allow you to make wise decisions and educated choices while finding individual health insurance.

When going down the list of basics naturally the total amount the insurance carrier will pay is a huge factor. This is what they call the Lifetime Maximum. It simply means that they will never exceed that amount if you should reach it. On average they are $3-$5million. When thinking in terms of a major critical illness that can easily cost millions, this amount could be your deciding factor.

Deductibles also make a significant difference. The deductible is the amount you must pay out of pocket before the insurer will share any cost. A general rule is the higher the deductible the lower the premium will be. When you hear the term "Total out Of Pocket' it is referring to your deductible plus your co insurance.

After meeting your set deductible you may the start paying a percentage of your occurred medical expenses. This is what insurance companies refer to as co insurance. You may have a 70/30 plan with a maximum of $2000. So the insurer would cover 70% while you cover 30% until the maximum was met, at which time the insurer would pay 100% for the remainder of the year.

Another often misunderstood part of insurance is Co Pays. If your plan has built in Co pays for Office Visits you pay only the co pay amount even if you have not met your deductible or co insurance. There are some exceptions, if not noted in the plan as included in office visit you would still have to pay lab and x-rays.

A good understanding of the Preventative benefit is also key to comparing and understanding your benefits. Not all plans include Preventative visits. A Preventative exam is a screening and non diagnostic exam meant to maintain good health and foresee any problems with health. Sometimes the benefit will cover many different test and labs, while some will only cover a certain amount.

Each plan has limits set forth by the carrier/insurer/insurance company as well. Some examples of limits are: You are only allowed a specific number of office visits. You are allowed a certain dollar amount on things such as prescription benefits, labs, mental health and emergency visits. These are important to pay attention to when choosing and comparing plans.

Some catastrophic plans do not cover prescriptions. It is crucial that you understand this. On the more benefit rich plans you can expect to pay a co pay for you prescription. But take notice if you have a maximum the carrier will pay, some prescriptions can be very costly. - 15255

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