If you have ever gotten sick but perhaps not at the point that you must seek professional medical treatments, you probably juggled with the fine prints on the costs through your insurance. What must you pay if you seek that chiropractor session? What about a certified massage therapist (cmt)? How about treatment while out of state or network? The list of terms below details the most common key cost related items in your heal insurance.
Premium: the per-month payment you make for your health insurance.
Copayment: the amount a person must pay for a particular service before the insurer pays the rest of the bill. For example, a $20 co-payment on a $100 dentist visit means that you have to pay the first $20 before the insurance company pays the rest of the visit- $80. If your plan has a high copayment, going for checkups too often may cost you lots of money.
Deductible: amount a person must pay per year for medical costs before the insurer starts covering their costs. For example, someone may have to spend $500 on doctors’ visits and prescription pills, etc, before the insurer would start paying for those costs. Higher deductibles usually mean lower premiums, so high-deductible plans make sense if you don’t anticipate much in health costs.
Coinsurance: a percentage of total medical costs that a person has to pay. Can vary based on service; your coinsurance percentage for medicine may be different than that for visits to the doctor.
Exclusions: what’s not covered in your health insurance plan. Keep an eye out because this may turn out to be the biggest cost of all.
Coverage Limits: the maximum amount a health insurer will pay for, for any combination of: per service, annually, lifetime. This can kick in quickly if the insured has an expensive chronic disease, leaving them to pay most of the bill.
Stop-Loss Limits: the maximum amount of coinsurance that a person has to pay out-of-pocket before the insurer assumes all the costs.
