BlogSpot.PK|The General Purpose Blog

Unless you are familiar with health insurance then the costs involved in a medical insurance plan may appear to be a little bit complex and many people are surprised that, having paid what seems like a small fortune, they find themselves landed with a bill the very first time that they make a claim. So before you are landed with an enormous medical bill therefore, it might be a good idea to take a moment to learn just what goes to make up the cost of individual health insurance.

The first and most obvious cost is the monthly premium or, in some cases, the quarterly premium or annual premium. If you are a member of a union or employer’s group plan then you will generally be asked 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 will also include an annual deductible which is an amount of money that you will be required to pay before the insurance company begins to pay out on any claims. In other words, with an annual deductible of say $1,000 you will need to pay the first $1,000 of your medical bills each year before your insurer will begin paying out. You might be familiar with paying a deductible from your experience with car insurance policies and, if so, will know that the more the deductible on your plan the lower your premiums will be. Also, if you have a family health insurance plan then this will frequently include deductibles for each family member covered under the plan.

Some medical plans will also include a co-payment which is a fixed sum of money which you will need to pay towards every medical bill. Exactly how much you will need to pay in co-payments will depend very much on the type of policy which you hold. For instance, co-payments on HMO plans are normally lower than those on indemnity plans. Additionally, the co-payment can also vary between different forms of medical service and, if you are a member of an HMO plan, will normally rise if you are treated outside of the HMO network.

In cases where a co-payment is not required you will usually find that this is replaced by co-insurance which is very similar and is an amount of money, in this case expressed as a percentage, which you will again be required to pay towards each medical bill. A common co-insurance ratio is 80/20 meaning that your insurer will pay 80% of each medical bill while you pay 20%. As for co-payments, co-insurance will normally increase if, as an HMO plan holder, you seek treatment outside of the HMO’s network. In this event you may also find that, where a claim exceeds what is considered by the insurance company to be ‘reasonable and customary’, you might be required to pay the additional cost.

By now you will realize that comparing health insurance policies is about much more than merely comparing plan premiums. As a consequence, it is extremely important for you to read the details of any health insurance quote most carefully and that you avoid the frequent temptation to just pick the plan which has the lowest monthly premium.

If you want to keep your costs low and are a member of an HMO plan then you should attempt to stick inside the HMO’s network and, where you do feel that it is necessary to go outside of the HMO’s network, then compare the actual cost of treatment to what your insurer considers ‘reasonable and customary’ before you undergo treatment.

It is also possible to keep your costs down on many plans by raising or lowering your deductible and by selecting higher or lower co-insurance. Exactly how this can be achieved is beyond the scope of this brief article but is a question of balancing the different costs against the probability of having to claim on your policy.

This may appear to be a little complicated but a good understanding of the different costs which make up your total expenditure is extremely important when it comes to getting the best deal and finding a suitable low cost medical insurance plan.