Health Insurance Plan Costs Explained
Premium. The first and most obvious cost is the plan premium which is the amount you will pay monthly (or occasionally quarterly or annually) for the benefits covered under your health insurance plan. If you are a member of a group insurance plan arranged by your employer or a union then you will normally only be required to meet a percentage of the premium.
The Deductible. Most health insurance policies will includes an annual deductible and it is very important that you understand the details of any deductible applied to your policy. A deductible is a sum of money that you will have to find yourself before the insurance company begins paying out on any claims. In other words, if your annual deductible is $1,000 then you will need to pay the first $1,000 in medical bills each year before the insurance company will start paying out. As with other forms of insurance, such as car insurance, the higher the deductible on your policy the lower your premiums will be. A family health insurance plan will typically include multiple deductibles for the various members covered under the plan.
The Co-payment. A co-payment is a fixed sum of money that you will have to pay on each medical bill. The amount of the co-payment differs according to the type of health insurance plan you have and is typically lower on an HMO plan than it is on an indemnity plan. The co-payment can also vary for different types of medical service and, if you are a member of an HMO plan, will normally increase if you seek treatment outside of the HMO network.
Co-Insurance. Co-Insurance is the sum of money, expressed at a percentage, that you will be responsible for paying on each medical bill. A common policy ratio is 80/20 which means that the insurance company will pay 80% of a claim and you will pay 20%. This percentage will often increase if you are a member of an HMO plan and go outside of the HMO's network. In addition, where a claim exceeds what the insurance company considers to be "reasonable and customary" for the treatment undertaken you may be required to meet the additional cost.
As you can see comparing health insurance plans is about much more than simply comparing premiums and it is vitally important whenever you request a quote, particularly if you are asking for a quote online, that you fully understand the range of costs involved.
To keep costs low in an HMO plan always try to stay within the HMO's network and, if you go outside the network, then be careful to compare the actual cost of treatment against what the insurance company considers "reasonable and customary" before undergoing treatment. You can also control costs by raising or lowering the deductible on many policies and by selecting higher or lower co-insurance. Be careful though to balance these against the likelihood that you will need to claim on the policy.
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