Do You Know How the Costs Of A Health Insurance Policy Are Worked Out?
Unless you are familiar with medical insurance then the costs involved in a health insurance plan may appear to be a little complex and many people are surprised that, after they have spent what seems like an arm and a leg, they find themselves landed with a bill the first time they submit a claim. Before you are hit with an enormous medical bill therefore, it is a good idea to take a moment to understand just what goes to make up the cost of individual health insurance.
The first and probably most obvious cost is the monthly premium or, in some cases, the quarterly premium or annual premium. If you belong to a union or employer’s group insurance plan then you will usually be required to pay only a percentage of the premium and this will usually be taken directly from your pay check.
The majority of health insurance plans also include an annual deductible which is an amount of money which you will have to pay before the insurance company starts paying out on any claims. Thus, with an annual deductible of $1,000 you will have to meet the first $1,000 of your medical bills each year before the insurance company will start paying out. You may be familiar with paying a deductible from your experience with car insurance policies and, if so, will also know that the more the deductible on your policy the lower your premiums will be. Also, if you have a family medical insurance policy then this will typically include deductibles for each family member covered by the plan.
Some health plans will also include a co-payment which is a fixed amount of money which you will be required to pay towards each medical bill. Precisely how much you will be required to pay in co-payments will depend very much on the type of policy you have. For example, co-payments on HMO plans are frequently lower than those on indemnity plans. Additionally, the co-payment can also vary between different types of medical service and, if you have an HMO plan, will usually rise if you are treated outside of the HMO network.
In cases where a co-payment is not required you will generally find that this is replaced by co-insurance which is very similar and is a sum of money, this time expressed as a percentage, that you will once again be required to pay towards every medical bill. A typical co-insurance ratio is 80/20 meaning that the insurance company will meet 80% of each medical bill while you pay 20%. As for co-payments, co-insurance will normally rise if, as a member of an HMO plan, you are treated outside of the HMO’s network. In this case you will also find that, when a claim exceeds what the insurance company considers to be ‘reasonable and customary’, you could be required to pay the additional cost.
By this time you will see that comparing health insurance policies is about far more than simply comparing plan premiums. Accordingly, it is critically important for you to read the details of any medical insurance quote very carefully and that you avoid the common temptation to merely pick the plan with the lowest monthly premium.
If you want to keep costs down and are a member of an HMO plan then you should attempt to remain inside the HMO’s network and, when you do feel that it is necessary to go outside the HMO’s network, then compare the actual cost of treatment to what the insurance company considers to be ‘reasonable and customary’ before you agree to treatment.
You can also keep your costs under control on most plans by adjusting the deductible and by opting for higher or lower co-insurance. Precisely how this can be done is beyond the scope of this short article but is a question of balancing the various different costs involved against the likelihood of having to make a claim on the plan.
This may seem somethat complicated but an understanding of the various different costs which make up your overall expenditure is very important when it comes to getting the best deal and finding a suitable private health insurance plan.

Posted October 31, 2008