Understand your health insurance

Today's offering is a guest blog by Joseph Luther, who works for an insurance company.

Health Care Insurance is front and center these days with the creation of the Affordable Care Act.  There is so much to know about health insurance.  Some young people are under their parents' plan till the age of 26, or you’re in your first job and the company offers health insurance as a part of the benefit package. 

The plans that are offered have different coverages, what providers are contracted, and what is needed to have the service covered.  When you are an adult, it is your responsibility to understand and know how your coverage works. 

Here are some basics that will help you to understand how Health Insurance works.

• Effective date
• Deductible
• Copays /Coinsurances
• Out of Pocket Cap

 
Effective Date:  This is when the plan starts.  Find out when you plan starts before going for services. If you're working, you can check with your HR department, or you can always call the Insurance Company. Sometimes there may be a delay of the information that was sent from HR to the Insurance Company, so you want to make sure you are covered.
 
Deductibles:  The deductible is what you pay out of pocket before your coverage benefits will be active. Some plans have a deductible and they can range from $100 to $4000. There are also plans with no deductible at all.  For example, you have a $100 deductible and go see your Primary Care Provider.  If the cost of that office visit is $325, you will be billed the $100 deductible plus the copay for that office visit.  Now that the $100 deductible is met, your benefits will be active going forward.  Deductibles are annual and will occur each year.
 
Copays / coinsurance:  Copays are the amount you will pay for the office visit or other services like an inpatient stay. This sets a limit on what you pay for the service. Coinsurance refers to a situation where the insurance company covers a percentage and you pay the remaining percentage.  With coinsurance it is best to find out the cost of the service before having it done.
 
Out of Pocket Cap: This will be the most you pay for medical services within a plan year.  Once the out of pocket cap is met, all covered services for the rest of the year will be paid in full by the insurance company.
 
I think these are terms that you should know about your health insurance.

For those people under their parents plan, you should know that your coverage will end 31 days after your 26th birthday.  Once that happens,  you have to find your own plan through your employer or the Health Exchange.
 
Joseph Luther is a gay man who lives in the Seattle area.  He works for Group Health Cooperative, a local insurance company and health care delivery system.