Healthcare companies have opened their doors for open enrollment for 2021, giving many the opportunity to keep their current healthcare coverage or change it. With a wide variety to choose from, the task can seem daunting with all the verbiage and lingo that is involved.
Inner Circle Billing is here to help aid this tumultuous process with a few things to keep in mind when deciding what healthcare policy to go with. Besides looking to see what is covered and isn’t covered for services that you need for yourself; it is also important to keep this in mind too when deciding.
Premium – the set amount of money paid to the health insurance company to have the health insurance for the month.
Employers will often offer healthcare coverage to their employees with the employee paying for it at a lesser price than they would have.
Deductible – the amount of money you pay the health insurance company for them to start paying for your services at a certain percentage.
For example, if you have a $1,000.00 deductible, you’re responsible to pay the $1,000.00 before your healthcare insurance starts kicking in.
The percentage paid depends on a few factors: 1.) are you In Network with doctor/professional you’re seeing. 2.) or, are you Out of Network. – this In or Out will determine what percentage the healthcare plan will pay for services and how much you’re liable for, if anything at all.
Out of Pocket Maximum – this is the most amount of money you will have to pay all year to be covered. The out of pocket typically includes all your deductibles and co-insurance payments. However, it does not include your premium.
For example, if you have a $5,000.00 out of pocket, you’re responsible for paying the entirety before healthcare starts paying 100% of the allowed amounts for services. But, if your out of pocket includes your $1,000.00 deductible, then you are actually responsible for $4,000.00.
Trying to decide what you need in healthcare coverage and what you don’t need is a task only you will know. For most people, they only need or want coverage for a typical doctor visit or coverage in the event an emergency room visit is needed.
Healthcare insurances offer a variety of metal tier-based plans depending on how much health insurance coverage you will need. And also depending on the metal tier, the healthcare insurance will offer you a type of plan.
PPO – this stands for Preferred Provider Organization – choosing a healthcare plan that offers coverage for PPO providers allows you to choose whomever you wish to see, specialist or not, without needing a referral from your primary care doctor. There is freedom with a PPO plan.
HMO – this stands for Health Maintenance Organization – choosing this healthcare plan offers you the availability to see doctors/specialists that are only in the HMO network. However, the premium for HMO plans is lower. Going outside the HMO network makes you solely responsible for all charges incurred in your visit.
EPO – this stands for Exclusive Provider Organization – choosing this plan offers you a combination of both PPO and HMO. It does not give you the absolute freedom of a PPO but it gives a little more than an HMO with emergency visits being covered even outside of your allowed network.
Inner Circle Billing Inc wishes you all the best. Stay healthy, Stay safe.