Peoples Clinic Morehead
October 11, 2020
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Don't Buy Health Insurance - Until You Speak the Language

Author: Administrator
Feeling a bit ignorant on the subject of health insurance? Don't worry, most of us avoid the topic entirely, until we find ourselves with a burning need to shop for a new policy -- and even then we put if off because we feel intimidated by the language. But if you take a minute to examine the language of health insurance, you'll find most of the terms are really just common sense. Let's take a quick look:

1. Deductible. This is the amount that you are expected to pay before any benefits from your health plan can be used. Usually stated as an annual amount, the deductible is gradually reduced as you incur medical expenses throughout the year, and then it is reinstated in full at the beginning of each year. If your health plan covers your family as well as yourself, each member of the family will used be subject to a separate deductible. Tip: if you have used your full deductible for the year, try and squeeze in any elective medical treatments before the end of the year.

2. Co-Payments. In addition to your deductible, you may be expected to pay for part of certain medical treatments or prescription drug expenses. When you're shopping for health insurance, ask if the policy provides access to basic medical services, such as annual doctor visits, by just paying the co-pay, even before your deductible is met. This is a fairly standard feature of most health insurance plans.

3. Out-of-Pocket. As the name implies, these are the medical costs that you pay yourself. It includes deductibles, co-payments, and any medical expenses that exceed the benefits provided by your policy. Many health insurance plans include an annual cap on out-of-pocket expenses, limiting the total cash payments you have to make -- excluding premiums paid for the policy itself.

4. Lifetime Maximum. Most insurance policies will limit the amount of benefits that the insured can receive over the lifetime of the policy. Each family member who is on the policy may be subject to his or her own lifetime maximum, and there may be a total lifetime maximum applied to the family as a whole.

5. Exclusions. Each health insurance policy will undoubtedly carry a number of medical expenses that are excluded (not covered) by the insurance company. These exclusions can vary greatly between insurance plans but may include: experimental treatments, cosmetic surgery, private or in-home nursing, and many more. You may be able to purchase a separate rider or policy that covers some of these benefits, particularly dental, vision and maternity coverage, but it's important to be aware of all exclusions before you buy health insurance.

6. Pre-Existing Conditions. This may well be the most common exclusion found in a typical health insurance policy. You will generally be required to disclose any prior medical diagnosis or treatment when you apply for a new health plan, and most insurers won't provide benefits for health conditions that existed prior to the start of the new plan.

7. Waiting Period. Most health insurers impose a 30-90 day waiting period from the start date of your new plan before they will start providing benefits. This means that you (or your previous insurance company if your old plan is still in effect) are responsible for all medical expenses until the waiting period has expired.

Tip: it's a good idea to keep your old policy active while you're shopping for the new policy, and until any waiting period has expired, even if it means paying the premium yourself for a policy provided by a previous employer.

Now that you are a bit more familiar with the language of health insurance, you are ready to begin shopping and comparing quotes for a plan that best fits your needs.


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