5 Things to Consider When Choosing Your Health Coverage

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5 Things to Consider When Choosing Your Health Coverage

Postby TimHangton » Sat Oct 01, 2022 1:23 pm

Choosing health insurance can feel like an overwhelming task. Here are five things to consider when choosing health insurance for you and your family. For detailed information on each benefit, see the Summary of Benefits and Coverage (available from the insurance company), call the insurer directly or visit the insurer's website.

1. Type of Plan and Health Care Provider Network

Are your preferred health care providers, hospitals and pharmacies part of the plan's network?


It is important to remember that services and medications that are part of the network are covered under a plan, while services and medications that are not part of the network may incur additional charges or not be covered at all. It is important to note that the cost of out-of-network services does not count against the maximum amount a plan provides. Check to see if your preferred primary care physician or specialist and your local pharmacy are included in the plan's network.

2. Premiums

How much do you pay per month for coverage?

Premiums are the amount you pay to the insurance company for coverage, whether or not you use medical and pharmacy services. Premiums are usually paid monthly, and if you stop making payments, you risk losing your coverage. Remember, these are not the only costs associated with insurance coverage. For most health services and treatments, you will also have to pay deductibles and cost-sharing, such as copayments and coinsurance.

3. Deductibles

What is the amount you must pay out of pocket before your coverage kicks in?

For example, if your deductible is $1,000, your PPO health insurance will not cover most costs until you have paid $1,000 out of pocket. Expenses you'll have to pay out of pocket include specialist visits, treatment fees, and even prescriptions in some cases. Certain preventive services, such as approved cancer screenings and immunizations, are usually covered without cost-sharing before you reach your deductible. Patients who choose a plan with a high deductible will most likely have a lower monthly premium, while lower deductibles are often associated with higher monthly premiums. Insurers are increasingly requiring a deductible before covering most medical or pharmaceutical services. Check with your insurer to see if your plan has a combined deductible for medical and pharmacy services, or a separate deductible for prescription drugs, to find out how much you will have to pay before drugs are covered.

4. Co-pay or Coinsurance

Do you know the other costs you may have to pay to receive services?

Don't forget that even after you reach your deductible, you will still have to pay other out-of-pocket costs. These may include:
- Coinsurance - a percentage of the cost you have to pay for a drug or service; or

- Co-pay - flat charges you must pay for prescriptions or covered services (often listed on the back of your insurance card).

5. Coverage of Medicines

Are your regular prescriptions covered by your insurance plan?

Each insurer has a list of drugs that are covered by the insurance plan. If a drug is not on the list, it may not be covered, and patients will then have to go through a potentially lengthy process to get it covered or you can go health insurance near me. The list of covered drugs is also divided into different tiers that determine how much of a co-payment or deductible you may have to pay. Make a list of your current medications and compare it to the insurance carrier's list to make sure your medications are covered and you know what costs you may face.
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Re: 5 Things to Consider When Choosing Your Health Coverage

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Re: 5 Things to Consider When Choosing Your Health Coverage

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