How does my health insurance work?

What is a Co-Pay?   

This is your portion you always will pay when seeing any provider of medical service.  This is not counted toward any deductible.

What is Premium Cost?

1.  You sign up for insurance coverage.  Based on your age and medical conditions you are quoted a monthly Premium cost for health Insurance.
2. You or your employer may pay for you.  If you pay, it is paid out of your gross pay before taxes are taken out.

If your employer pays and doesn’t deduct from your gross pay it is considered a benefit and really will impact your personal cost for healthcare. (For the better)

• Once you have coverage and use the insurance to see a doctor.  You will be subject to a “Co-Pay” which you will pay every time you have an encounter with your medical provider.  Usually $35-$50 even if your deductibles are met.
• When you visit the provider, you pay the co-pay and any unmet deductible at the time of service.  It is your responsibility to know this prior to your visit. This information can be obtained from your insurer. (the contact information usually is on the back of your card) Once the visit is complete the insurance company is billed for the services rendered; once the claim is received and approved payment is sent. 
• For diagnostic testing (stress tests, echocardiograms, etc.) another copay and separate deductible is charged, even if performed in the doctor’s office.  The co-pay amount you pay is included in the total amount the insurance companies agree to pay the provider this is your portion.

What is A Deductible?  

            Much like auto insurance; before the insurance company pays anything on your behalf you will pay the deductible amount first.  ($1,500 deductible – You pay the first $1,500 in addition to the co-pays before your insurance company pays anything on your behalf.

            Most plans have separate deductibles for Prescriptions, Hospital and Emergency Room visits, Outpatient diagnostic tests and physician visits.  These can be hidden in the fluff, but the total of all the deductibles is reflected in the “Total Out of Pocket Cost “$3,500-$7,500 for Individuals, and $5,500-$13,000 per family.

The Most Important Number for You to Know is:   Total Yearly Cost YOU pay before you get benefit from having traditional health insurance.

Total Yearly Cost = Total Insurance Premiums paid for the year (If your employer pays, you should check to see on paystub if it’s taken out of your gross pay like taxes) minus  Employers Contribution amount not taken from your gross ) + Max out of Pocket (Total of all Deductibles) + Co-pays