Insurance?! It’s so scary!
It’s October, and to many of us, that means it’s time to consider our options for health insurance for the coming year. Insurance can be confusing and intimidating no matter what type it is, but if you know a bit about the terminology, it might not seem so scary!
Let’s take a look at premiums—a premium is the monthly amount you pay to have any kind of insurance, health, auto, home; usually paid on a monthly basis, some paid quarterly or yearly. A premium will vary depending on the company who is providing the insurance. Some companies “bundle” the types of insurance together, while others strictly have one type of insurance.
The deductible is the amount you must pay out-of-pocket before health insurance begins to cover the cost of health care services. With health insurance, the deductible can be for the entire family or individually. It is important to read the material on your policy to make sure what type of deductible you have.
Coinsurance is your share of a covered health service, calculated as a percent (20 percent for example) of the allowed amount for the service. You will have to pay coinsurance plus any deductibles you owe. For example, if the health insurance or plan’s allowed visit for an office visit is $100 and you’ve met your deductible, your coinsurance payment of 20 percent would be $20. The health insurance or plan pays the rest of the allowed amount.
Copayment or copay is a fixed amount you will pay for each covered health service. The amount can vary by type of covered health service, such as for specialists or emergency room visits. Copayments are usually requested by the health care provider before you receive the care, such as a doctor’s visit, or will be listed as part of your responsibility on an itemized bill from the health care provider.
Network refers to the facilities, providers and suppliers your health insurer or plan has contracted with to provide health care services.
Provider network refers to a group of doctors, specialists or facilities with which insurance company contracts. The copayment to see a network provider is generally less than an out-of-network provider. Some providers are referred to as “in-network” providers, which means they are contracted to be a part of the network of doctors or hospitals who agrees not to bill patients for amounts beyond the agreed on fee. Out of network providers are ones who are not part of the contracted network. Fees are often higher for these providers.
Preventive care is care intended to prevent illness or keep you healthy. Examples include flu shots, well woman, well man or well child visits or routine screenings.
Diagnostic care is care intended to address symptoms or conditions you may already have.
Inpatient describes a patient who has been formally admitted to a hospital by an attending physician. Outpatient is a patient who has not been admitted to the hospital.
Don’t let insurance be scary! For more information about the different types of insurances, please contact the Golden Prairie Extension District – Oakley Office at 785-671-3245.
By: Amy Lorenzen, Family & Consumer Science
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