I work as customer service representative for Marketplace and Medicare. I took the job with the idea of learning about health insurance as much as possible. I thought I would share some of my knowledge and help break down some of the terminology. Health insurance can be very confusing and hard to understand. The terminology and the way healthcare is processed can be a daunting.
You have your deductible which has to be met by the consumer before the plan itself pays its portion. Some preventive services are paid out by the plan before the deductible is met. Think of it almost like car insurance. When you get into an accident you have to meet the deductible before the plan covers the expenses of the accident, and the deductible will be applied to certain medical services. Usually the plan will dictate what medical services are a part of your deductible. A copay is a set rate you pay for prescriptions, doctor visits, and other types of care. Coinsurance is the percentage of costs you pay after you've met your deductible. Investopedia Out of pocket costs is what you pay during the annual coverage year that is not covered by the insurance policy.
In-network has to do with what providers take the insurance policy and out of network are the providers that are out of the service area. Some companies will cover you out of network expenses but it may be a portion of the cost. Every company is different and covers different services at a certain cost. There is a lot of information and a lot of different components when it comes to health insurance. Also, remember there are sometimes other things that are covered that do not pertain to health care. Some companies may help pay for utilities bills or provide a card to purchase groceries. Usually you have to apply for these types of services.
Along with some of the cost sharing and out of pocket expenses there are different types of plans. HMOs and PPO are the most common. HMO stands for health maintenance organization and PPO stands for preferred provider organization. The main difference between these plans are: HMO plans typically have lower monthly premiums. You can also expect to pay less out of pocket. PPOs tend to have higher monthly premiums in exchange for the flexibility to use providers both in and out of the network without a referral. Out-of-pocket medical costs can also run higher with a PPO plan.Women's Health.
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