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What is the health? Lay leaders for the confusing world of health insurance



Whether you are completing your own health insurance for the first time or switching plans after a major change in your life, you probably have a lot of questions. That's okay. This stuff can be very confusing.

It is also very necessary. Taking some time to improve your understanding of health insurance can bring significant benefits.

"Consumers can put hundreds or even thousands of dollars on the table if they make that choice wrong," says Professor Amanda Starc, a professor who studies at Northwestern & # 39; s Kellogg School of Management ,

To help you get it right, we turn to the experts to answer some of the most common health insurance questions and to clarify concise answers.

What is a deductible?

A deductible is the amount you must pay for health care before your plan actually begins. If your deductible is $ 1

,500 (about the average deductible for a single plan being offered (by an employer), your plan will not pay for the care until you spend so much on covered benefits. [19659003] In some plans including all plans on the Marketplace the exception to these are preventive services.These are often covered, even if you have not yet reached your deductible. (Do not worry Worry, we'll be provisioning in no time.)

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What is a premium?

These are the actual costs of your plan Ask your or your employer your premium monthly, quarterly, or annually. Your premium is different from your deductible and payments on your premium do not count for your deductible. Good question (and good try).

What is an additional payment?

An additional payment is the fixed cost of a particular covered health service, also known as "the fee you pay when you leave the doctor's office." The amount varies depending on the service – $ 20 for your family doctor and $ 40 for a specialist.

This is confusing, not the same as co-insurance. Co-insurance is a percentage – your share of what you owe for the covered care . Assume your co-insurance is 20 percent and your annual physical cost would otherwise be $ 200. Assuming you've met your deductible, you would pay your copay plus $ 40 – your 20% co-insurance.

"All health plans are required to give a summary of benefits and coverage," says JD Professor Sabrina Corlette at the Center for Health Insurance Reforms . It's a short document that lists what's covered by your plan and what's not. She says Co-Insurance and Co-Pay amounts appear here, and sometimes Copay fees on your insurance card are correct. So you can always know it before you go.

What is precaution?

This refers to services designed to help people stay healthy and detecting or preventing disease – checkups, counseling (eg on alcohol abuse), checkups and shots are covered under this umbrella , The full list of Adult Care Providers can be found here .

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What is an HSA?

A HSA is a bank account on which you deposit money for health care expenses before taxes. The IRS limits how much you can contribute – for 2019 it is $ 3,500 per person and $ 7,000 per family.

Both you and your employer can contribute to an HSA, says Corlette, and you do not have to count the money as income tax-exempt for any qualifying health service. The IRS outlines all of these but your deductible, your copay, your co-insurance, and your prescriptions are all (teeth whitening, gym fee, and calf implants? N that much.)

HSAs are often available through employers and highly deductible health insurance plans. (As a rule, any plan with a deductible of at least $ 1,350 for one person or $ 2,700 for a family.) You can also open one through some banks.

Can I see a doctor?

Not exactly. Your health insurance company builds a network of doctors and hospitals (called "in-network") and offers them patients in exchange for lower prices, explains Starc. So-called "out-of-network" documents are not part of this pact. So you pay more out of pocket (see below) to see them.

Even if a hospital or medical center is on the network, it does not mean that all of its doctors are, Starc warns. Therefore, make sure your doctor makes sure before you leave.

What exactly do I have to pay out of my own pocket?

Let's say you do not talk about co-pay, co-insurance or premium, and your deductible is met if you do not pay. & # 39; When you visit an In-Network doctor, you pay. And remember, out-of-network means higher prices. Fortunately, there is something like a out-of-pocket maximum – the most you would have to pay in a year, with no bonuses and spending on services your plan does not cover. For the 2019 plans, Max out of pocket is $ 7,900 for an individual plan and $ 15,800 for a family plan. Different plans could have lower maximum amounts.

Do you think your insurance company should have been paying for something they did not do? You can appeal your decision by writing a letter or filling in a form asking them to review the indictment internally, Corlette says. A clinical examiner will evaluate and reassess the initial decision. If this fails, you can forward the call to an external reviewer.

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Is my recipe covered?

This is listed in the forms named in your plan. Corlette: Again You have the right to appeal if you ever think you have been unfairly or wrongly sentenced.

What will be treated in an emergency?] You should always go to the nearest hospital, wherever you are If the hospital is out of the network, you may not be billed under the Affordable Care Act (ACA) If you are in an emergency room at a hospital where you are not insured in an emergency, says Corlette. [19659003] Unfortunately, she says that hospitals can still charge you, and while some state laws protect people from these bills, not all of them do, which unfortunately means you even in an emergency, try to get into a hospital that makes the most of your plan.

What is an open enrollment?

This is the period of each year (usually November to December). when can someone sign up for a new health insurance ? However, this is not the only time you can get a new plan.

You can also take out health insurance through your employer when you start a new job and when you experience an event known as qualifying, such as marrying or losing your previous coverage.

Unfortunately, getting a clear answer to all these questions is not a qualifying event. However, if you have the time to make your next health insurance decision, you can be sure that you do not leave anything to chance or put money on the table.


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