Three Parts of Health Insurance
Benefits Benefits are simply what your plan covers – things like checkups, prescriptions and medical care. Your health plan covers some benefits, like wellness visits and preventive care, at 100%. In other cases, like with surgery, you may pay a deductible and your health plan then covers a percentage of the cost, and you pay the difference. Overall, the more your health plan pays toward your medical costs, the higher your monthly payments (premiums) will be.
Networks When you buy a health plan, you choose a network. A network is a group of doctors, hospitals and other health care providers who provide services at negotiated rates on behalf of the health insurance companies members. When you buy a health plan and you use a doctor or hospital outside of your network, you pay more, so it’s important to understand which providers are included in your health plan before you enroll.
Costs You’ve probably heard about health insurance costs like premiums, deductibles, co-payments and co-insurance. These play a big role in helping you manage your health care expenses.
For example, you can choose a plan with a higher monthly payment, or premium, and lower out of pocket costs (deductibles and co-insurance) on the actual services you use to help you budget for expected medical expenses. On the flipside, you may have few or no expected health needs, which means you may consider a lower premium plan with higher out of pocket costs.
That’s a lot to remember, so for now, here’s a simple tip to keep in mind.
Remember, network and coverage choices affect what you pay for your health plan. For example:
Health plans with smaller provider networks usually have lower monthly payments, but they include fewer choices of innetwork doctors and hospitals.
Health plans with greater benefit coverage and lower out of pocket costs – like deductibles and co-insurance – but they have higher monthly premiums.