Understanding the fine print of your insurance policies

September 03, 2019

When you purchase your health insurance, your insurer may send you a packet in the mail or in an email outlining your benefits, costs of care and other detailed information on your plan. The multitude of details and hard-to-understand lingo can be intimidating, but identifying key terms of your benefits policy can be a good start to determining what will be covered or not. Let’s walk through a couple:

• Network Providers: Not all hospital, doctors, pharmacies and other providers will take your insurance. Receiving care from providers that accept your insurance will help you avoid any additional costs that may be incurred from service received out-of-network. Familiarize yourself with providers nearby that are in-network so you are prepared if you ever face a medical emergency.
• Premiums: One of the most important costs related to your insurance is the “premium,” which is the cost you pay each month. Choosing the lowest premium isn’t necessarily the cheapest health plan option, but finding a balance between premiums and deductibles will help ensure you find the best fit.
• Deductibles: This is the amount you must pay for care before your insurance can cover costs. Deductibles can vary.
• Co-payments: These are out-of-pocket costs you pay for a service. Insurance providers typically charge co-pays for services, and these vary from service to service. You should check your insurance plan to make sure you are never paying more than the co-pay for doctor’s visits.
• Out-of-pocket maximums: This indicates the most you will have to pay per year out of pocket, with your insurance covering the rest. These maximums can vary, but are important benchmarks to look out for to ensure you are not spending more than you should.

These are just a few components to look out for, but remember you can contact your health plan’s member services department at any time to better understand what your plan covers and what it doesn’t. You can also visit mypatientrights.org to find additional resources about some basic health care rights.