Understanding Health Insurance Deductibles, Co-Pays, and Out-of-Pocket Maximums

Your health insurance is a crucial investment in your long-term health and well-being. These policies can ensure you and your loved ones can access the preventive care needed to stave off illnesses while also assisting with medical services and products following eventual ailments. However, while you’re likely aware of the importance of health insurance, ensuring you have the right policy can be a complicated process. There are several key clauses of which you should be aware.

What Do I Need to Know About My Coverage?

While health insurance policies can come in many forms and each is typically capable of being customized to suit your unique circumstances, coverage does share many key components. As you analyze your needs and assess available options, be sure to scrutinize the following clauses in available policies:

• Deductibles—These are the amounts that you’ll be required to pay out of pocket for covered services before your insurance carrier will begin to contribute aid. Some services, such as immunizations and annual physicals, are exempt from the requirement to meet this threshold.

• Copays—These are flat fees set by your insurance company that you’ll need to pay out of pocket for specific services. For example, when visiting your general practitioner for a checkup, most of the appointment cost may be covered, but you’ll still be responsible for the copay.

• Coinsurance—This functions similarly to copays, but instead of a flat fee, a percentage of the total cost of a procedure or service is your responsibility.

• Out-of-pocket maximum—This is the most that you can be required to pay, including deductibles, copays and coinsurance, for covered services in a single plan year. After reaching this amount, your insurance will cover 100% of all care and services included in your policy throughout the remainder of the coverage period.

• Premiums—This is the amount you’ll need to pay regularly (e.g., monthly or quarterly) to maintain your coverage. These payments do not count toward reaching your out-of-pocket maximum.

Get the Right Coverage

Contact Ashley Taylor Insurance today to learn more or compare personalized health insurance quotes.

This blog is intended for informational and educational use only. It is not exhaustive and should not be construed as legal advice. Please contact your insurance professional for further information.