How to Read a Health Insurance Plan without Getting Lost in the Fine Print
You purchase health insurance in support of your family’s health and well-being but knowing what your policy actually covers can feel like a guessing game. When you’re making decisions that pertain to health insurance, worrying about the fine print is the last thing you need. Making important insurance decisions based on wordy and confusing plan documents doesn’t inspire confidence. In response, our Pennsylvania health insurance professionals at My Health Benefits Made Easy offer plain language coverage explanations that bolster peace of mind.
Health Insurance in Pennsylvania
Many residents throughout Pennsylvania face challenges regarding health insurance affordability and rate hikes. The complex jargon that is so closely associated with health insurance policies amplifies related concerns.
This highlights the importance of having clear explanations and a side-by-side comparison of the policies you’re considering at your fingertips. When it comes to your family’s health insurance, you shouldn’t have to guess.
Understanding the Basic Plans
While health insurance varies considerably from policy to policy, most plans fall into specific categories.
Preferred Provider Organization
A preferred provider organization (PPO) allows you the flexibility to choose your healthcare providers, but those who are out of the network will come with a higher price tag. Exclusive provider organizations (EPOs) implement more restrictive options.
Health Maintenance Organization
Health maintenance organizations (HMOs) are common in Pennsylvania, and if you choose one, you’ll need to pick a primary care physician (PCP) who is within the organization.
Point of Service
Point of service (POS) plans are a hybrid of HMOs and PPOs. While you’ll need to choose an in-network PCP, you can also pay more for out-of-network care.
Knowing the Basic Terms
When it comes to comparing and contrasting insurance policies and choosing the one that’s right for you, it’s a good idea to have a solid understanding of key terms like the following:
- The premium refers to the amount you’ll pay each month or period for coverage under the policy.
- The deductible refers to the amount you’ll be required to pay out-of-pocket before insurance coverage kicks in.
- The copay is a fixed amount that you’ll pay upfront for covered healthcare services like doctor visits, appointments with specialists, and prescriptions.
- Coinsurance determines the percentage of the medical expense that you’ll be responsible for once you’ve met your deductible. 20 percent is common.
- In certain instances, your health insurance policy may require you to obtain approval, which is called preauthorization. Non-emergency surgeries are a common example.
- Many health insurance policies include an out-of-pocket maximum or limit. This represents the maximum amount you will be required to pay out-of-pocket for covered medical care during the coverage term, which is generally a year.
- Most health insurance policies address both in-network and out-of-network providers. Because they negotiate better rates with in-network providers, you can expect lower costs.
Our Experienced Pennsylvania Insurance Pros Can Help
Our trusted Pennsylvania insurance specialists at My Health Benefits Made Easy are here to effectively translate the fine print of the health insurance policies you’re considering. The idea is to decode policies so you can make informed decisions that serve your family well, learn more by getting started here today.