Monday, April 8, 2013

How To Shop For Health Coverage

Helpful information for BXBS



Can I Afford It?


When you're buying health insurance, cost is just one factor to consider. Plus, there are many ways you can reduce your costs so you can afford what you need. Learn about your costs and options here.
When shopping for health insurance, your first concern may be whether you can afford it. Many people assume they can't afford health insurance and take the financial risk of being uninsured. But the good news is that once you know how insurance works you can pick a plan and choose options that give you the affordable health insurance you need.


Affordable Health Insurance and Premiums

The first thing you may think of when shopping for affordable health insurance is the premium. How are premiums determined?
  • Health insurance companies use data about the costs of medical treatments and the trend in costs to predict future medical expenses.
  • Premiums are based on claims paid in the past and expected future claims, as well as the balance of relatively healthy individuals with less healthy individuals insured by the company.
  • When insurers pay out more than they receive, or when future services are predicted to cost more, premiums may go up.
  • Use our Premium Meter to see how different factors may impact your monthly premium.


Affordable Health Insurance and Deductibles

One cost-saving option that many plans offer is an annual deductible. A deductible is the amount you pay out of your own pocket within a specified period of time, usually twelve months, before benefits begin. Here is how it works:
  • Since you assume some of your own medical expenses, your premium is lowered.
  • The higher your annual deductible, the lower your annual premium.
  • Once you "meet" your annual deductible, benefits begin and last until the end of the calendar year.
  • At the beginning of a new year, you must meet the deductible before benefits start again.
Having a deductible can trim your premium and make health insurance more affordable. How do you decide on the deductible amount? Usually there are several levels offered per plan. You should choose a level that you can pay without causing financial hardship on you or your family. You should also consider the annual difference in premium versus deductible to determine under which premium-deductible combinations you are most likely to pay the least.


Other Factors for More Affordable Health Insurance

Take time to learn how your health plan works. If you do, you may save money. Some examples:
  • Avoid additional costs to you by staying within the plan's network.
  • You may be able to reduce your expenses by choosing generic drugs.
  • Take advantage of money-saving member discounts on things like gym memberships and vision services.
  • Check into special incentives for taking part in programs to quit smoking, lose weight, exercise or other healthy activities.
Once you understand all the variables that affect your cost, you can find an affordable health insurance plan that's just right for you…and your budget.

Understanding Costs

When you shop for health insurance, you have to make your decisions about what to buy based on your financial situation and health care needs.
If you know you will be using your insurance quite often, you may choose to pay a higher premium in exchange for a lower deductible. This means that you'll pay more upfront for your benefits, but the amount you have to come up with out-of-pocket when you go to the doctor over the course of the year will be less.
This also works in reverse. If you know you don't typically have a lot of health care expenses, you may choose to go with a lower premium. Your deductible will be higher, but you are taking the chance that you may not need to spend it all during the year.
Many plans also include copays or coinsurance, which are amounts that you pay directly to your care provider for things like office visits.
Here's an example of how it works for you.
You have an insurance plan that has these basics:
  • $5,000 deductible
  • 20% coinsurance
  • Out-of-pocket maximum of $6,000
Under this plan, you will be responsible for paying for the first $5,000 of your medical costs. After that, your plan covers 80% of the costs, and you pay the remaining 20%. When the amount of coinsurance you've paid reaches $6,000, the plan covers 100% until your "plan year" renews. A plan is good for one year. At the beginning of the next plan year, your deductible and coinsurance resets for the next plan year and the $5,000 deductible and 20% coinsurance will start again.
When buying health insurance, it's important that you know how your plan works so that you are aware of potential costs. Learn about how insurance works and explore typical cost scenarios.
When you're shopping for insurance, the total cost of keeping you and your family healthy is a top concern. You want your plan to cover your total health care costs as much as possible, you want affordable premiums, and you want any out-of-pocket health care costs to be minimal. To help you shop for a plan that meets all of these factors, it's important to understand the costs that go into buying and using health insurance.
  • Shopping for individual coverage? Use our Premium Meter to see how different factors may impact your monthly premium.
  • Selecting coverage through your employer or another group? Use the Health Plan Cost Estimator to evaluate insurance plan options and estimated annual costs.

Your Total Health Insurance Cost and the Network

When you choose a plan, one thing to consider is the size of their network. It's your lifeline to quality and convenient care. A specific network of doctors, hospitals and other health care professionals, sometimes called providers, helps keep your premiums low for a number of reasons:
  • Network doctors and hospitals have agreements with the insurance company that save you money
  • Services are provided at a lower rate to members
  • Streamlined expenses, such as billing, keep costs down
  • Providers are held to certain quality standards for plan members
When you choose care outside a specified network, benefits and costs can change. Every plan is different, however, some plans provide limited coverage and others offer no coverage at all for out-of-network services. Since doctors, hospitals and other health care professionals outside the network don't have an agreement with your insurance company, the price of services may be higher.
When you're shopping for insurance, look closely at the plan network. Check to see if you will be able to get as many services within the network as possible, or that you'll have options, if you decide to go outside the network.

Other Expenses That Affect Your Total Health Insurance Cost

Your total health insurance cost can also be affected by your out-of-pocket expenses. There's the copayment, which is usually a small fixed amount you pay per visit to in-network doctors. That's not to be confused with coinsurance. That's the percentage of costs you may be responsible for within your plan, once you satisfy your deductible.
For example, let's say you've met your annual deductible, so your plan now pays for benefits. You may wonder what you will have to pay if you visit your doctor. The answer depends on the percentage your plan pays for medical services that are covered under the plan.
For example, you bruise your hip in a fall and you need an X-ray. Your plan covers 80 percent of an X-ray. Here's how the costs might break down:
  • The X-ray costs $200
  • Your plan covers 80 percent, which is $160
  • Your out-of-pocket cost, or coinsurance, is $40 for the X-ray
That's a simple example. You should also be aware of the maximum limit for a procedure or medical service specified in your plan. These limits help keep rates to a fair and reasonable standard, which helps lower costs for all members.

To illustrate this, let's say that, for some reason, your doctor charges more for an X-ray:
  • The maximum covered cost for an X-ray in your plan is $200
  • Your doctor charges $300
  • You may be responsible for the $100 difference
So, when calculating your out-of-pocket costs, two things to remember are the percentage that is covered by your plan and the limit for any specific service you'll be using. You also need to consider your out-of-pocket expense limits. The out-of-pocket expense limit represents the maximum amount you are responsible for each year. Once the out-of-pocket expense limit is reached, insurance covers 100 percent of eligible expenses.
When you understand some of the costs of buying and using health insurance, it's easier to find the plan that's best for you and your family. Best of all, you'll be able to get the most out of the plan you choose.
 

Health Plan Cost Estimator

Use the estimator tool to create a health profile to evaluate insurance plan options and estimated annual costs.
If your employer has given you an eight-character pass code to access your employer group's Health Plan Cost Estimator tool, enter the code below.
 

Health Insurance Coverage: What Is and Isn't Covered?

If you're shopping for health insurance coverage, you should know that every plan is different. Some plans cover the majority of care while others limit your health insurance coverage to major medical benefits. It's important to know exactly what is and isn't covered, so there won't be any surprises down the road.

How Health Insurance Coverage Works

Health insurance coverage is the package of services that an insurance company has agreed to pay. To understand what may or may not be covered, it's helpful to look at a few basics.
  • Your doctor may decide you need certain tests, treatments or procedures out of medical necessity.
  • A medical benefit is something your plan has agreed to cover, either partially or fully.

Health Insurance Coverage Limits

Knowing your health insurance coverage limits ahead of time is important. Some expenses may not be covered, and some may only be partially covered. Just a few of these limits may include:
  • Care that your receive outside your plan's network
  • Plan restrictions for certain types of care
  • Over-the-counter drugs
  • Alternative therapies, such as massage and acupuncture
  • Behavioral health therapy
  • Cosmetic surgery
There are plans available that may cover some of these types of expenses. Some plans offer at least partial health insurance coverage for treatment from doctors and hospitals outside their network. On the other hand, over-the-counter drugs are rarely covered. So it's a good idea to look at a plan carefully to see what is fully, partially, or not covered at all. Then you can plan for and budget your out-of-pocket expenses.

The Right Balance of Health Insurance Coverage

Balancing what you can afford and the health insurance coverage you need is the key to finding the right plan. Here are a few tips for finding the right plan.
  • It's best to choose a plan that covers services you'll use frequently — even if it means a higher premium — because it will save you money in the long run.
  • For greater cost savings, select a doctor within the plan's network.
  • Take the time to read the details about the plans you are considering — ask for the Outline of Coverage.
  • If you have any questions about your health insurance coverage, contact a customer service representative.
Be proactive and learn about the coverage of plans that you are considering. It will help ensure the best health care for you and the ones you love.

Questions to Ask When Choosing Health Coverage

Picking a health insurance plan doesn't have to be complicated. Part of making the best choice is knowing what questions to ask. Use this list to compare health insurance plans before making your decision.
  • Is there a monthly premium? If so, how much?
  • Is your current doctor or hospital part of the plan's provider network?
  • Is there a deductible?
  • Is there coinsurance?
  • Will you have copayments?
  • How does the plan handle visits to the emergency room?
  • Are hospitalization and major medical expenses covered?
  • What is the policy's annual individual (or family) out-of-pocket expense limit? What costs are included vs. excluded in the out-of-pocket expense limit?
  • Is there a waiting period before you're fully covered?
  • Are there limitations to the policy such as pre-existing conditions? (Not applicable to Dependent children under age 19)
  • Do you need additional coverage, such as dental, vision or prescription drug coverage?
  • Are you planning any major medical expenses for the following year (for example, having elective surgery)?
  • What do your friends, family, and doctors say about the company you are considering?
 
Posted by at
Labels: , , , , , , , ,

No comments:

Post a Comment

Subscribe to: Post Comments (Atom)