From pricing to benefits and more, here’s what you need to know.

Finding the right health insurance for you and your family can seem like a scary prospect, and the explanations can be complicated and confusing.

The Insurance Twins want to make the process of finding the perfect plan as simple as possible.

Every person/family is different. Some have more medical needs than others. How often do you need to visit your doctor or specialists? What recipes do you need? Will you need maternity services? This is what to consider:

What are you going to pay?

Take a close look at the premium, deductible, and copay for each plan.

Your premium is what you pay monthly (or in full).

Your deductible is what you pay out-of-pocket before insurance covers the costs.

Your copay is the amount you pay to visit a doctor, specialist, emergency departments, and urgent care. The more you pay in premium, the less you pay in copayments and vice versa.

What is a network?

Some plans will cover visits to any doctor, while other plans are limited to specific doctors. When comparing plans, make sure your doctor is in your network so your services are covered by the plan. If you visit a doctor not included in your plan (out of network), you will pay for their services out of your own pocket.

How much?

You are probably aware that you pay a monthly amount (premium) for health insurance, but that does not mean that your health care is then free. That’s when it can seem complicated. Copays, coinsurance, deductibles, oh my! Making sure you get the right insurance for you at an affordable rate is easier when you understand these terms.

A copayment is the fixed amount you pay after your deductible for covered health care services. For example, if it costs $75 to visit your primary care doctor and your copay is $20, you only pay the $20 if you’ve met your deductible. If you have not met your deductible, you will pay the full $75 for the visit.

In general, the higher your monthly premium, the lower your deductible, and vice versa.

Your deductible is the cost you pay for health care services before your insurance begins to cover any expenses.

For example, let’s say you have a deductible of $2,000. First, you have a $1,000 emergency room visit for a broken arm. Unfortunately, that broken arm was not put together properly and you will need surgery. If that surgery costs more than $1,000, your insurance will start to pay a percentage of the remaining cost. This is called coinsurance. Different plans have different percentage splits. Therefore, if your plan’s coinsurance is 70/30, you pay 70% of the remaining cost while your insurance pays the remaining 30%.

This is the maximum amount you will spend in a year before insurance covers eligible health care services 100%. Out-of-pocket maximums or OOPs are a combination of the amount you pay before hitting your deductible, your copays, and your coinsurance.

As with copays, the higher your monthly premium, the lower your OOP maximum, and vice versa.

Doctor and Prescription Coverage

Doctors, hospitals, and other providers decide which health insurance plans they accept. If they accept your plan, they are considered in-network. If not, they are out-of-network.

So what does this mean for you?

Health care services received outside of the network will not be covered by insurance, which means that 100% of the costs will be borne by you, except in the case of an emergency. If you already have a primary care doctor you want to stick with and are changing insurance plans, please contact them to see which plans they accept. If you don’t have a doctor yet, your insurance provider will be able to tell you which doctors in your area are in the network.

Most insurance companies have a prescription drug list, or PDL, that includes drugs covered by the plan.

Now, this does not mean that the prescriptions that are not on the list are not available to you, but they will cost more.

If your prescription is not on the PDL, ask your doctor if there are comparable alternatives listed. If that is not possible, and the price of your drug is too high without the help of insurance, you may consider changing plans.

Also, like providers, certain pharmacies may be considered in or out of network. Be sure to check with your insurance provider which pharmacies are in your network to keep your costs as low as possible.

Do you still have questions? We are here to help. Call us and we will help you find the perfect plan for you!