Five Essential Health Insurance Facts You Must Know

Health insurance is a type of insurance policy that covers the medical and surgical expenses of the insured. But this definition doesn’t do justice to itself. Health insurance does take care of most of the cost, but not all.

Many people planning to buy health insurance in San Antonio TX, think that once they buy health insurance, they don’t have to worry about medical expenses, but it is not so. You have to keep paying your part for healthcare for a certain amount. So it is important that you clearly understand how health insurance works.

Here are five essential health insurance facts you must know before buying a health insurance policy:

1. You have to pay deductible, copayment, and coinsurance

Many people have a misconception that premium is everything in health insurance, but it is not. You have to pay for out-of-pocket costs like deductibles, copayments, and copay. A deductible is an annual amount an insured must pay out of pocket before the insurance company pays any expenses. For example, if you have an annual deductible of $500, then you have to pay that amount out of pocket before your health insurance starts paying for covered healthcare services. The copayment is the fixed amount you pay every time you receive a covered service. For example, you might pay $20 when you visit the doctor, and your health insurance pays the rest of the amount. Coinsurance is a percentage of costs that the insured must pay for services once the deductible is met. For example, you may pay 20% of the total allowed costs of service, and the plan would pay the remaining 80%. So apart from monthly or annual premiums, these are the out-of-pocket costs that you have to pay.

2. You have a limited network of doctors and healthcare providers

A typical health insurance plan provides you coverage within a network of doctors and service providers. Different plans offer different coverage. So you need to understand if you see a doctor outside your network, you could be stuck paying a higher coinsurance percentage. And often, there are higher annual coinsurance and overall out-of-pocket limits if you visit doctors and healthcare providers outside your network. Sometimes you have to pay for 100% of the costs while visiting a doctor out-of-network area.

3. You may have to pay for prescription drugs

Not all health insurance plans provide you the prescription drug coverage. If you do not have prescription drug coverage in the plan, you have to pay for the medications. Make a list of any prescription drugs you take and ensure they are included in your plan. Look out for dollar caps and other limitations and exclusions.

4. Your employer’s plan may not be the best one

Most of the people have a health insurance plan from their employer. And these health insurance plans usually are group plans. So they have premiums and benefits based on the group, which may not be in the best interest of you. Group plans are good if you are not in good health. However, if you are in good health, it is best to get a policy on your own. More importantly, when you buy an employer’s health insurance plan, you don’t have any choices left. You get stuck to whatever is offered in the plan. For example, if you want to see your current doctor and he is not in your plan, then you don’t have any choice left. On the other hand, when you buy health insurance in San Antonio, TX, on your own, you can look for a plan that covers doctors you want to see.

5. Plan with the lowest premium is not the cheapest

Many people, while buying health insurance, usually tend to buy a policy with lower premiums, but it needs not necessarily the cheapest overall. Out-of-pocket costs such as deductibles, copayments, and coinsurance can add up to the overall cost. So before you buy health insurance in San Antonio, TX, take out-of-pocket costs into account.

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