How Well Do You Understand the Fine Print of Your Health Coverage?

We all understand the importance of health insurance. And, we all understand the importance of getting good coverage for ourselves. But, while the policies are usually sold with slogans saying that everything is covered, and that the premiums are affordable, or similar things, it is important for you to realize that some of those statements are purely marketing related, and that you do have to check things before making any final choices.

Read more about the importance of health insurance in general: https://www.healthcare.gov/why-coverage-is-important/ 

What’s more, you have to understand that the actual reality of the coverage lies in the fine print, that is, in the details, and not in those marketing slogans and bold statements. It is not uncommon for people to get a certain policy without actually understanding what it entails, what it covers, as well as how the costs are really shared. This leads to quite some surprises in the future, often unpleasant ones, after you realize that you haven’t really understood everything clearly, and that you aren’t covered for what you have experienced, for one reason or another.

I am sure that this sounds like something that you really don’t want to happen to you. Well, in order to avoid such surprises, you should do your best to actually get a clearer understanding about the coverage. That is, you have to really understand the fine print of your health coverage, so as to be absolutely sure that you know what to expect in every single situation.

This is, of course, much easier to say than to do. What we are going to do right now, thus, is talk about those things that people usually get confused about, and that result in them being surprised with the amount of money they actually have to pay after a certain medical intervention. By understanding the fine print, and some important concepts that play a role in how much you will really be paying, you’ll be much better prepared to not only form realistic expectations, but also choose your new health coverage in case you wind up being unhappy with the current one. Or choose your first one for that matter. Click this to even better understand why health coverage matters that much.

The Key Terminology That Confuses

Now, the insurance terminology can undeniably be quite confusing for the regular person, and that is completely normal. What we are going to do right now, thus, is talk about the key terminology that actually confuses, and that results in some unpleasant surprises along the line. So, to cut right to the chase, the main thing to do here is understand the difference between deductible and out-of-pocket maximum.

Figuring out what these two terms mean is sure to reduce the confusion, at least to a certain extent, and to, thus, help you understand your policy much better. You’ll know how to read the fine prints, and you’ll know how to read between the lines. So, let us now explain these two concepts in more detail, hoping to shed light on what you need to know about this specifically.

First things first, let us talk about deductibles. To put it simply, this is the amount of money that you will have to pay out of your own pocket for those covered health services before the insurance company actually steps in and starts covering your costs. For instance, if your deductible is, say, $1,000, you will have to cover that amount first for your healthcare costs in a certain period, usually a year, after which the insurance company will start covering the expenses. While most plans have this particular requirement, it is worth noting that some services, such as, for instance, some preventative care services, are actually exempt from deductibles, meaning that they are covered fully before the deductible, but this is clearly something to check with your insurance provider.

Next, let us cover the out-of-pocket maximum, which is another confusing term, that is, a term that people often confuse with the one talked about above. Basically, we are talking about the highest total amount that you will have to pay for covered services in a given policy year. Once this amount is hit, the insurance company pays for all the rest of your medical costs for the rest of the insured period, and for the covered services, of course. 

Why This Confusion Costs Money

Now, as mentioned previously, lot of people confuse these two terms, and this can actually cost them money. How come, though? Well, when you don’t know the difference between out of pocket vs deductible, that can lead to you misjudging how much coverage you may actually get and how much you may have to pay yourself. And, I suppose you understand that this is a confusion that can surprise you quite unpleasantly when you have certain medical costs to cover.

Some people may assume that no further costs will apply once they have reached their deductible. Forgetting that coinsurance and copays definitely still apply if they haven’t reached their out-of-pocket maximum. And then, others will assume that all their medical expenses will be covered once the deductible is met, when it is only the actual covered services that count. This could result in people getting plans that appear to be cheaper, but that can turn out to be much more expensive in the long run.

How to Understand Everything Better

Okay, you now get that understanding the fine print matters. And that understanding the deductibles and the out of pocket maximums is extremely important. But you may not be sure how to understand this better if you’re not quite well versed in the actual terminology.

Well, it is always a good idea to talk to the professionals before choosing any specific plans. Ask any questions you may have, and don’t shy away from asking twice, or even more times, if things are still not clear to you. The bottom line is that the professionals will explain, so you just have to ask and listen carefully, as that’s how you’ll ultimately choose the best plan.