Questions on Health Insurance

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Health insurance is a pretty broad topic, so it's natural to have a few questions. Get answers to all of your health insurance questions with help from an experienced insurance professional in this free video clip.

Part of the Video Series: Health Insurance
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Hi, my name's Tim Tracy, co-founder of InsuringCT.com, and I'm here today to talk to you about some answers to general questions regarding health insurance. Some of the more popular questions we get are, first, what is a deductible? A deductible is a fixed amount that you have to pay prior to the insurance carrier actually paying out your claims. So, for instance, let's say you have a plan that has a $1500 deductible. You're going to be responsible to pay that first $1500 prior to the insurance carrier kicking in and paying for their claims. One of the other common questions we get is, what is a co-pay? Well, a co-pay is a fixed price that you have to pay for a specific service. Take, for example, your doctor's visit with your primary care. If your plan says that you have a $25 co-pay, every time you go in and see that primary care doctor, you're going to pay $25, and the insurance carrier is going to pick up the remainder of the cost. If you have a co-pay for a hospital stay that's $250, you'd be responsible for that $250, and after that, the insurance carrier is going to pick up the remainder of the cost. Another common question, what is co-insurance? Co-insurance is going to be the percentage of the bill that you pay after any deductible or co-pay that's applicable. So, for example, if you have a health insurance plan with a $1000 deductible and twenty percent co-insurance, the first $1000 is going to be your responsibility. After that, the insurance carrier is going to pay eighty percent of the remaining bill, and you're going to be responsible for your twenty percent co-insurance. What is an out-of-pocket maximum? An out-of-pocket maximum is the bottom line cost that you would have to pay out of your pocket, any calendar year, for medical services. So, let's take for example an out-of-pocket maximum of $5000. If you had a $2500 deductible, you would pay that. After your $2500 deductible, the insurance carriers are going to pay their co-insurance, and you're going to be responsible for your portion, up to that $5000 out-of-pocket maximum. Once you hit that out-of-pocket maximum, the insurance carrier is then going to pay a hundred percent of your in-network services. If you go out-of-network and you hit your out-of-network out-of-pocket maximum, the insurance carrier is going to pay a hundred percent of, typically, what's deemed reasonable and customary. So, if you go out-of-network and you go to a doctor that charges more than every other doctor, you're going to end up being balance billed, because the insurance carrier is not going to pay a hundred percent of whatever that doctor's charging. They're going to pay a hundred percent of what's deemed reasonable and customary. What is a PPO? A PPO stands for Preferred Provider Organization and is one of the more common plans that you'll see in the marketplace. Basically, a PPO has two networks. They have an in-network benefit and an out-of-network benefit. You always are encouraged to utilize your in-network providers, and that's where you're going to get the best bang for your buck. But you also have the ability to use any provider you choose, whether they participate in the network or outside of the network. If you go to a doctor that does not participate in the PPO, you're still going to receive benefits, just not as rich as you would if they were in-network. What is an HMO? An HMO stands for Health Maintenance Organization. A Health Maintenance Organization is an in-network only plan. So, you have to utilize in-network doctors and facilities in order to receive benefits from the insurance carrier. If you go out-of-network to a non-participating provider, you're going to be responsible for the entire cost. What is an HSA? An HSA is a health savings account, and it has two portions: the first being the health insurance plan. To qualify for an HSA, you need to have a qualifying high deductible health insurance plan. This means that, besides your preventative care, for all your other services, it's going to be applied towards that high deductible. The second portion to the HSA is the savings account. You're allowed to set up the savings account with the bank of your choice, and you're allowed to contribute money into that account on a pretax basis to help you pay for your deductible and other qualifying medical expenses. And those are some answers to general questions regarding health insurance. My name's Tim Tracy, co-founder of InsuringCT.com.

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