While a large number of Americans enjoy the benefits of health insurance through an employer, the vocabulary and processes associated with a plan can cause confusion.
According to a 2015 U.S. Census Bureau survey, more than half of the nation’s population, about 67 percent, have health insurance coverage through their employer. But surveys conducted by Carnegie Mellon University researchers found evidence that a large number of Americans who are enrolled in these programs don’t understand how health insurance works.
If you don’t understand how your plan works, you might be missing out on plan benefits or overpaying for health care expenses.
With research, you can uncover resources to become more educated about health insurance. Here are some examples of where to go for information.
While every employer health plan is different and benefits can vary between plans, having access to your plan-specific information is important. Consumers can access this information through their human resources representative or by visiting their insurer’s website.
Many health insurance plans have online tools to find more information about your benefits. These tools can also help you communicate with your doctor, schedule appointments or video chat with a medical professional for non-emergency situations. There are also resources to help refer you to an in-network doctor.
Aside from assisting you find and get the right care, some health insurers also offer you tools to help save money on your health care expenses. Check with your insurance provider to see if they provide a Cost Estimator tool so you can research your costs before receiving your care. This prevents surprises and allows you to shop around for the best care at the lowest cost.
Take advantage of all the tools in your health insurance toolbox to get the most from your employer health plan.
Decoding the Cost
One of the most important things when it comes to understanding your health insurance plan is knowing what you will be required to pay for and what your plan pays for. This information isn’t always easy to digest because many health care terms seem similar, but have very different meanings.
Here is a helpful list of common terms related to health insurance costs and what they mean to you.
Deductible: This is the amount you pay each year before your health plan starts paying for certain services. After meeting the deductible, the plan pays a portion of the total cost for the health care services you received.
Coinsurance: After you meet your deductible, you may be still be responsible for paying for a percentage of your medical costs. Coinsurance is your portion of the costs that you must pay for your medical expenses or approved prescriptions.
Copayment: This is the amount you pay when you receive a health care service such as a doctor’s appointment. It is also sometimes referred to as a copay.
Premium: A premium is the monthly payment made by an individual to an insurer so that coverage remains active.
More terms used by health insurance plans can be found in the summary of benefits, which is often available on your insurer’s website. The summary will also include explanations of the benefits you have, coverage examples and an insurer’s contact information.
By taking charge of your health and knowing what benefits you have, you’ll not only be a more informed customer, but you’ll get the most out of your health plan.