Important Health Insurance Facts
When shopping for health insurance, you should consider the costs, provider network, and benefits. You should also know the definitions of key terms like premium, deductible, and out-of-pocket maximum.
Costs
- Premium: The monthly cost of your insurance plan, even if you don’t use it
- Deductible: The amount you pay before your insurance starts paying for covered care
- Copay: A fixed amount you pay for certain services
- Coinsurance: The percentage of costs you pay after meeting your deductible
- Out-of-pocket maximum: The most you’ll pay in one year for covered services
Provider network
- In-network providers Make sure your preferred doctors and hospitals are in-network for any plan you’re considering
- Out-of-network providers If you use providers outside your network, you may be charged more or your claims may be denied
Benefits
- Prescription drug coverage: Consider which prescription drugs are covered and how much your plan will pay toward them
- Dental and vision coverage: Some plans don’t offer these services, so you may need to add them on
Other considerations
- Whether you can afford the out-of-pocket maximum
- Whether you need to seek referrals from your primary care doctor
