With a considerable number of companies offering health insurance in so many shapes and sizes, it is easy to see why the consumer remains at a disadvantage when selecting coverage plans. Most comprehensive insurance plans contain similar types of coverage but there can be significant differences in how they are delivered how much they cost. There are three main areas of concern with any comprehensive policy.
A co-pay in your health insurance policy is the amount that the insured must pay out of pocket before any benefits are paid for doctor visits. In addition, the co-pay usually applies to different providers. For example the policy may requires a $35 co-pay for the primary doctor visit, a $60 co-pay for a visit to a specialist and a $100 co-pay for treatment in an emergency room or clinic. The consumer should determine these fees up front and consider them carefully before purchasing a policy.
Deductibles will typically apply to hospital stays, diagnostic tests, and medical equipment. The insurance policy deductible is the amount the insured must pay out of pocket services before the insurance company will pay benefits. In today’s marketplace, many companies have elected to offer higher deductibles rather than substantially raising their rates. There are extremely high deductibles available but these should be approached with caution as they can result in high out of pocket costs for medical care.
Co-insurance is the percentage of costs for a covered claim paid by the insured instead of the insurance company. For example, many companies offer an 80/20 split to help keep rates more affordable. This split however, means the insured is responsible for 20% of their medical costs and the insurance company are responsible for 80%. There is usually however, an out-of-pocket maximum for the insured that is stated on an annual basis. For example, your policy may pay on an 80/20 split but have a maximum out of pocket of $10,000. This means that once this maximum has been reached, the insurer will begin to pay 100% of expenses.
There are many insurance companies marketing many different flavors and sizes of insurance plans. The consumer should do the research before purchasing and better yet, get advice from a reputable and knowledgeable agent.