Health Insurance Benefits
Health insurance benefits cover everything from prescription costs to clinic visits and hospital stays. All health plans are not created equal though, so it is very important to take the time to do your homework and find the right plan for you and your family’s medical needs.
Before you enroll in, or purchase, a new plan for health insurance benefits, there are several aspects you should take into consideration:
1. Carefully compare benefits and services of several plans before you choose one. Basic health care benefits include preventative care, office visits, emergency room and urgent care visits, and maternity care.
Additional services are generally subject to a deductible and will vary by plan type and level of coverage.
The Most popular Health Insurance Benefit Plans
The two most popular types of plans are HMO’s and PPO’s. HMO’s require prior authorization if you would ever need to see a specialist and PPO’s require you to see a physician of your own choosing but within a certain network.
2. Determine the deductible, co-pay, and coinsurance amounts you will be responsible for. Deductible amounts are usually available at $0, $250, $500, $1000, $2000 or $5000. Co-pays can range from $20-$50 depending on the service required at the time. Coinsurance amounts are generally set at 10 percent, 20 percent, 30 percent or 40 percent.
Many plans offer both in-network and out-of-network deductible and coinsurance. Out-of-network deductibles are usually much higher if they are available at all. The deductible must be met for all services subject to a deductible before insurance coverage kicks in to pay it’s share of your bill.
For example, a $500 deductible would need to be paid by you,the insured, before the insurance company pays for any services performed at your appointment.
Settling on a higher deductible may lower your premium payments every month but you will end up paying more out-of-pocket expense.
3. Review the pharmacy benefits closely. Most health care plans offer a pharmacy benefit, however this may only be limited to a discount service, and may also be limited to generic medications, as well.
Read the health insurance benefits terms carefully and determine the m onthly or yearly cost of the medications you take on a regular basis. Consider the yearly maximum the plan will cover, and be aware of guidelines regarding brand-name medications.
Ask for the formulary from the plan you settle on to see which medications are covered and available to you should you need them.
Carefully Evaluate Health Insurance Benefits
4. Evaluate other plan coverages like mental health coverage and chiropractic coverage. Many plans exclude mental health coverage unless the plan holder has an “extreme mental health condition”. For basic out-patient drug and alcohol treatment, or basic mental health therapy, your plan may be subject to a limited number of sessions. Generally, this number can range from 10 to 25 sessions per plan year.
The same holds true for chiropractic coverage. If this service is covered you may only get a certain number of visits ach year.
5. Determine if the plan offers a health savings account (HSA). An HSA is usually pre-tax and can be used to pay for any medical related expense. Use your pre-tax dollars to pay for any medical expenses with a card issued from your carrier.