Health Insurance Plan Basics

Health insurance isn’t known for being easy to understand. Whether you’re looking for your own insurance or buying your company’s group health insurance plan, there’s a lot to know, and many of the moving parts and terminology can be confusing (even to people that are in healthcare or insurance).

Many times, people receive health care plans and they are not entirely sure what their plan includes, what they are paying for, or what is or isn’t covered. If you’re confused about a plan, don’t purchase it until you understand the ins and outs of it.

Our team of certified agent brokers at Thomas & Associates insurance agency in Jacksonville, Florida, wanted to share with you some health insurance basic information so you will be more informed and less confused when looking over different coverage plans.

Even if it isn’t an open enrollment period for healthcare, it’s a good idea to educate yourself on healthcare knowledge, so you will know the best plan to choose for yourself in the future.

Health Insurance Plans Terminology Explained

  • Premium – A premium is the amount you pay for your health insurance plan monthly that will come out of your paycheck or banking account (depending if it’s through your workplace or not). If the insurance is through an employer, you only pay a percentage of the premium.
  • In-network and out-of-network – In network providers are physicians that your insurance company works with to get discounted rates. It will cost you and your insurance company less if you go to those providers. Out-of-network providers are physicians that your insurance does not work with, so it will cost you and your health insurance company more money if you go to them.
  • Co-pay – A co-pay is a set fee that you will pay for in-network services including a visit to the doctor, x-ray appoint, urgent care visit, etc.
  • Deductible – A deductible is the amount you must spend on health care in a year before the insurance company begins to cover a larger portion of the health costs. Once you meet your deductible, you are only responsible for a lower percentage of health costs. With lower premiums, come higher deductibles. Co-pays usually do not count towards deductibles in a plan. The deductible resets each year
  • Co-insurance – Co-insurance is the lower percentage you pay for your health care costs after hitting the deductible. If you have a 30 percent co-insurance, you only have to pay for 30 percent of medical bills after meeting your deductible and the rest is covered by your insurance company.
  • Out-of-pocket maximum – This amount is the most you would have to pay out of pocket in one year before your insurance company would cover 100 percent of future bills.

To sum up, each month you pay a health insurance premium – this amount comes out of your bank account or your paychecks monthly. When going to the doctor or getting any medical service or treatment, you must pay a co-pay. You will also pay any fees above until you meet your plan’s deductible. Once you meet the deductible, you will pay a co-insurance rate for all future medical expenses. If you reach your plan’s out-of-pocket-maximum, the insurance will pay for all future medical expenses until the policy ends for that year.

Your financial situation will help you determine how much you are willing to spend on premiums, co-pays, and deductibles. When getting a plan through a company, you may not have as much say on the rates; however, companies get better rates (usually) than individual’s do with their health care plans.

Do you need an individual or group health insurance plan?

If you’re in the market for an individual healthcare plan, insurance for small business, employer’s insurance, or a group health insurance plan, our certified agent brokers at Thomas & Associates insurance agency in Jacksonville, Florida, can help you get the most cost-effective plan for your needs. If you are confused by anything in the plan, we will help you understand the coverage and answer all your questions.

We take pride in finding you the right coverage. To get started with us click our Jacksonville health insurance contact page or call 904-730-3900 .


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