Affordable Health Insurance – How Do I Find the Right One, and What Coverage Do I Really Need?

I get questions everyday from people about health insurance, some are just getting out of school, about to get married and start a family, or getting a divorce and losing coverage, they have a need to know what benefits are available to them and how they work.
One of the most frequent questions I hear is “I don’t mean to sound stupid but what does deductible mean?” Trust me, there are no stupid you don’t know what someone is talking about ask them to explain it. A deductible is the set amount of money that you are required to pay yourself before the insurance company will pay on specific medical claims (like: hospital expenses, lab work, and x-rays). also, just to be clear your monthly premium does not go towards your deductible, you will always pay a monthly, quarterly or even annual premium, you have a choice when you are setting your plan up.
Shopping for health insurance can be a bit confusing. Another question I hear is “What is co-insurance?” Co-insurance is a percentage of money you will spend after you have paid out your deductible in medical claims for the year, most plans are 80/20,70/30, or 50/50 co-insurance. Let’s look at the 80/20 co-insurance plan this means after you have paid your deductible then the insurance company will pay 80% of your on-going claims for the rest of the year, and you will pay 20%. For example a medical bill of $5000.00 would be processed this way. If your deductible is $2000.00 you would pay the first $2000.00 and then the insurance company would pay 80% of the remaining $3000.00 which would be $2400.00 leaving a balance of $600.00 for you to pay.
Most plans being sold today are PPO’s which stands for preferred provider organizations. These providers have agreed to charge a set rate for their services. These set rates can give you huge savings in the discounted prices, for example a lab bill of $900.00 when processed by the insurance carrier has a unapproved amount of $600.00 which is like a red tag sale huge the bill is only $300.00 and the rest of it is a wash, you do not owe it if you used the PPO Network. See the savings.
When you are looking for a health plan you need to ask questions. You will be asked questions as well, like what is your gender, height and weight, zip code, if you or your spouse or girlfriend is pregnant, Valley Medical Center Lewiston Id do you smoke or use tobacco products, do you have any pre-existing conditions? All of these questions will determine what rate you will be given as well as what coverage will be offered to you.
Some questions you need to ask are: What is the waiting period for pre-existing conditions, is maternity covered, what is the lifetime maximum of the policy (the lifetime maximum is the maximum amount of money the insurance plan will pay in medical bills for you as long as you have the policy), which network of providers do you offer? This information is critical to you so that you can make an informed choice of coverage. There are many variables in the health insurance market, and all plans are not created equal.
The plans offered are not going to have everything covered, that is a myth. Dental and vision is not an automatic benefit and neither is maternity. You need to be aware that some pre-existing conditions will not be covered at all, or they could have a waiting period before they are covered. Sometimes, the pre-existing condition will cause you to be declined. If you are declined, don’t be discouraged. Just because one insurance company declined you does not mean they all will, keep trying with other carriers. Insurance underwriting is not the same, there are variables with every carrier.
Do you want a Dr. co-pay or a prescription co-pay, be aware not all plans come with these they do drive your premium up.
Most plans do not offer mental health or drug addiction benefits, if they do the benefits are usually limited. It is best to read the limitations Eat Healthy Quotes and exclusions section of the brochures and policy’s to make sure you have a clear understanding of what is covered and what is not.
Rate guarantee’s vary as well, and a birthday will cause an adjustment in your rate regardless of the rate guarantee.
I hope that this has been helpful information. Always remember to ask questions, it’s how we learn.