Updated: Dec 30, 2020
Purchasing a #healthcare plan corresponding to your medical needs is a complicated task that requires extensive research on the subject. As the Open Enrollment time is underway, we are here to answer your questions.
During the Open Enrollment – from November to mid-December – one can change his/her healthcare plan. Keeping this in mind, we have compiled some critical FAQs that will help you select the perfect plan to cover your medical expenses.
What are Tiers?
Let's start with metal tiers; there are four metal tiers in health insurance, namely: Bronze, Silver, Gold, and Platinum. Each tier represents how much a person would pay for healthcare in addition to premium costs. Bronze and Silver have lower monthly premiums but high deductibles, meaning you have to pay more if you get medical check-ups and tests. Gold and Platinum have high premiums and cover a larger portion of bills – minimizing out-of-pocket costs. So, people requiring regular medical care should opt for the Gold or Platinum tier.
What are Deductibles?
Deductible in health insurance is the money you pay for covered healthcare services before your plan begins. For $1000 deductibles, you need to pay the first 1000 dollars of your covered services, and after that, you pay only coinsurance or copayment for covered services – or pay a little portion of total expense. Generally, the premium costs are lower for higher deductibles.
Staying in-network offers enormous benefits to customers. Every insurance plan includes a list of doctors, hospitals, specialists, etc. who have an agreement with the provider to offer medical care at a discounted rate. When you visit these doctors and hospitals, the insurance company covers all your expenses.
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Now, every patient consumes prescription drugs that are generally very expensive, but you can save a lot of money on prescription drugs by:
Oder your long-term drugs shipped directly to you to get huge discounts.
Try generics as they contain the same formula as brand-name medication prescribed by the doctor, but they cost substantially less.
Before buying any medication, search if you can choose a prescription copay. These are the drugs that are covered under your health insurance plan. This information is available in your insurance's schedule of benefits. So, if you can switch to such drugs, it will save you a lot of cash.
Your medical specialist or doctor can get you in contact with manufacturers who offer discounts, rebates, coupons, etc. to the customers. Don't shy from asking your doctor about other resources that can help you save money.
The three basic terms that you come across too often in healthcare plans are covered, not covered, and covered-in-full.
Covered: When a service is covered in your health plan, it means the provider will pay for some or all of its expenses – either in the form of copayment, coinsurance, or deductibles. Depending on your plan, the company shares the cost of 'covered services.'
Not Covered: These services are paid in full by the customer himself and don't get any benefit from the insurance company. Generally, not covered services include non-essential drugs or services that are not medically necessary, like cosmetic surgery.
Covered-in-full: As the name implies, these are free services, paid in full by your insurance company. Typically, it includes annual check-ups and follows up tests.
We hope this article was helpful.
For more information, feel free to contact one of our experts.
*The information contained in this article is not legal advice and is not a substitute for such advice. State and federal laws change frequently, and the information in this article may not reflect your own state’s laws or the most recent changes to the law.