Health Insurance 101

Health Insurance 101

When it comes to health insurance, making any sort of decision can be overwhelming. There are so many different numbers and bits of information to know. It’s hard to know what information is important. In this article, we’ll explain the most essential numbers for you so you can make informed insurance decisions.

What is a premium?
A health insurance premium is an amount you pay regularly, regardless of whether you are making hospital visits. Typically, this amount is paid each month. When picking a plan, be sure to pay attention to whether the premium increases when a new year starts. You want to make sure your premium fits not only your budget at the moment, but also going forward into the future. Premium prices can change if you’re income, family size, or other personal details change.

What is a deductible?
A deductible is an amount you will need to pay on your own before your insurance steps up to start covering costs. Once you meet your deductible for the year, your insurance company will start to make payments for your claims.

Insurance companies will often cover (or help cover) medical expenses that can help prevent further problems, like yearly physicals, before you meet your deductible.

How are premiums and deductibles related?
If your insurance plan has a high deductible, it will typically have a low premium and vice versa.

What is an HSA?
HSAs (Health Savings Accounts) let you deposit tax-free dollars into an account that can only be used for medical expenses. They are often offered in plans with higher deductibles.

What is the difference between a copayment and coinsurance?
copayment is a fixed fee that you pay yourself to help cover the cost of your care. For example, you might pay a 10$ copay when you get a new vaccination. Some other costs that often include copays are:

• Brand name prescriptions
• Generic prescriptions
• Sick visits
• Visits to the emergency room
• Inpatient hospital care
• X-ray, lab, or diagnostic services
• Specialist visits

Choosing a plan with low copayments can save you a lot of money in the long run, but it can be difficult to find out which plans to offer them. If you want to quickly learn copayment costs for different insurance plans, Health Market will do this for you free of charge.

Coinsurance is a percentage split of the costs that you share with your insurance company. For example, they might cover 80% of a surgical procedure, whereas you cover 20%. It can be difficult to predict how much coinsurance will end up costing since you will not always know how much a procedure will be up front.

What is an out-of-pocket maximum?
An out-of-pocket maximum is the highest amount you’ll ever have to pay (for covered benefits) before your insurance company covers all costs. Premiums don’t usually count towards this amount, but deductibles and coinsurance do. When you’re choosing your insurance, having the right knowledge is essential. It can help you feel confident in making the right decisions for your health. A recent study indicated that 20% of respondents did not visit a doctor for their health issues because of cost concerns. In the same study, 44% of respondents didn’t know how much they would need to pay for prescription drugs, and 61% did not know how much it would cost to visit an urgent care clinic. You should never skip a visit to the doctor just because you’re not sure about the about numbers.


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