Friday, October 15, 2021 11:35 AM

Health insurance packages can be confusing and overwhelming to understand. There are hundreds of healthcare plans out there, and they each have a range of features that may differ from one to the next. Therefore, you will want to know what types of care your policy covers and the costs along each step of the way. 

You need to understand a myriad of terms to interpret what is covered under your health insurance plan and how it works. Here is a list of some things to look for when reading through your benefits package.


Your premium is how much you pay monthly for your health insurance. The money you pay goes into a fund that the insurance company uses to pay claims. Sometimes, your employer may pay part of the monthly premium while you pay the remaining amount. Usually, this is accomplished by deducting your portion of the premium from your paycheck. 


Your deductible is the amount you owe for covered health care services before your health insurance or plan begins to pay. For example, if your deductible is $1,000 and you have a $2,000 hospital bill, you will pay your $1000 deductible before the insurance company pays their remaining part.

Your deductible accumulates throughout the calendar year, so your insurance company covers remaining health care services throughout the year once you meet that designated amount. 


In most cases, coinsurance charges begin after you have met your deductible. The number may vary depending on your plan, but coinsurance defines the percentage of medical costs you are responsible for. This means that after you meet your deductible, you might have a portion of fees that you need to pay beyond that deductible amount. 


Some health care plans have co-pays. Usually due at the time of service, co-pays are the dollar amount you pay for office visits and prescriptions. Emergency room and urgent care co-pays are traditionally more expensive than primary care co-pays. 

Maximum Out-of-Pocket

Maximum out-of-pocket refers to the most you will have to pay out of pocket for in-network expenses in a calendar year. Maximum out-of-pocket will include payments for your deductible, co-pays, and coinsurance. Once you have met your maximum out-of-pocket cost, your insurance should pay your covered medical expenses for the remainder of the year. 


When examining your plan benefits, you will also want to identify what is in- and out-of-network. “In-Network” means that your doctor joined your insurance company’s network of healthcare providers and charges less. “Out-of-Network” refers to a doctor that has not partnered with your insurance company to lower the costs. As a result, you may have to pay part or all of the bill yourself. 

Health insurance can be confusing. Tom Miroballi, Independent BCBS Agent will explain the terms, rules, or whether the plan will cover something before you sign up. You and Tom will be partners working together to make your healthcare plan work for you! Give Tom a call at 630-863-3477 or email him today!