ContentWhen you start looking over your health care options, you might feel a little overwhelmed. All the talk of deductibles, in-network, out-of-network, and co-pays can leave anyone’s head spinning. By reading your plan carefully and asking the right questions, you can go into any appointment without worrying about what you’ll get charged.
The deductible refers to the amount that you have to pay out of pocket. The majority of plans have an initial deductible that is entirely paid for by you. This means that anything besides routine checkups has to be paid for by you; typically, the first $1,000, $2,000, or $4,000 is the deductible. The higher the deductible, the less you pay out of your paycheck for insurance. After the initial deductible is met, insurance companies tend to split the cost with you. For another $1,000, $2,000, or $4,000, the insurance company will pay 80% while you pay 20% of your health care costs. After this, the insurance company typically pays for 100% of your health care costs.
Out-of-network and in-network are two more confusing terms. Every insurance company has lists of doctors in every specialty that they will cover. If you stick to these in-network doctors, your deductibles and payments remain the same. However, if you go out-of-network, you have to pay more out-of-pocket. Additionally, the amount you pay out-of-pocket typically does not apply to your deductible. For these reasons, you should only go out-of-network when it’s absolutely necessary.
Co-pays are a big part of your health care plan. When you see a doctor that is a general practitioner, you typically have to pay a low co-pay for any checkups. If you see a specialist, such as an ob-gyn or cardiologist, you have to pay a higher co-pay for any appointments.
The best source for clarification on your health care plan is your insurance carrier; the customer service agents are always willing to answer questions.
