10 Basic Health Insurance Questions Answered: I Asked So You Don’t Have To

October 31 01:00 2015 by ushadmin

From deductibles, to premiums, to out-of-pocket maximums — buying health insurance can be wildly confusing.

I know this, because I am getting ready to buy health insurance for the first time and I am wildly confused.

At this point, you may be wondering what business I have trying to break down health insurance and all of its intricacies. I am clearly no insurance expert, nor do I have any interest in pretending to be.

But, I am a 23-year-old recent college grad who entered the working world about a year ago as an online producer for The Courant, and I am not too proud to admit that — when it comes to health insurance — I have questions, and I have a lot of them.

So, I reached out to an actual insurance expert, Kathy Walsh of the Connecticut Insurance Department, seeking answers.

And here we are.

This is where I attempt to pass on this newfound knowledge of mine to anyone who may be able to relate.

Still interested? Here it goes…

1. For starters, what’s a deductible?

A deductible is what you need to pay out of your own pocket for health care services before your provider will start paying its share of covered costs, according to the HealthCare.gov glossary.

Basically, if you have a $1,000 deductible, your provider won’t pay until you have already paid for $1,000 worth of services on your own dime.

The silver lining, not all services require you to meet your deductible first.

2. What services do not require you to meet your deductible first?

Preventive care is offered at no cost, according to Walsh.

Preventive care services include your annual physical, mammograms and generic brands of birth control, just to name a few.

“(These services) aren’t just what you consider to be preventive,” Walsh said. They have been identified by the U.S. Preventive Services Task Force and are listed here.

3. Do you still have to pay for services, other than preventive care, once you meet your deductible?

Yep.

Once you meet your deductible, you start to share the cost of services with your provider in the form of either a copayment or coinsurance, this is called cost sharing.

4. What’s the difference between a copayment and coinsurance?

It took me a while to understand this one, so bear with me here.

Walsh explained to me that you typically have either a copayment plan or a coinsurance plan.

If you have a copayment plan, there is a set fee (your copay) that you have to pay out-of-pocket for services. For example, you may have a $75 copay for a trip to urgent care and a $250 copay for a visit to the emergency room. The fee is determined by your provider and varies depending on the service…