Health insurance is something that most of us know little about. One of the top reasons why people overpay for medical bills is a lack of knowledge about their health insurance plans. When open enrollment comes around, we have to choose between several plans riddled with terms like “copay,” “deductible,” and “coinsurance.” Before selecting your next health insurance plan, let’s review six things you should know.
A health insurance premium is an amount that policyholders pay monthly out of pocket for health coverage. Think of this monthly payment as your subscription fee. Whether or not you use your coverage, most health insurance companies still require you to pay a monthly premium. Often, if enrolling in employer-based health insurance, a portion, if not all, of this is covered by your employer. Do you know how much yours is?
How much you pay for your premium depends on several factors, including age, location and the number of people covered on the plan. Typically if you have a higher premium, you have a lower deductible, and if you have a lower premium, you have a higher deductible. However, after completing a Baseline Visit with Curative within 120 days as a member, employees will have no deductible for comprehensive in-network services.
A deductible is an amount you pay for out-of-pocket costs for your covered health care before your plan begins to pay. For example, a patient is admitted to the emergency room and receives a $3,000 bill. If the patient has a $1,500 deductible, that person will not receive any health benefits or savings applied to their bill until they meet their deductible in full. Be sure to review your deductible, so you don’t experience sticker shock. If you complete a Baseline Visit with Curative Insurance Company within 120 days as a member, you’ll have a $0 deductible for all in-network services.
Coinsurance is the amount a patient pays for a covered service after their deductible has been met. Coinsurance is often confused with the term copay. For any medical bills you receive after you have met your deductible, coinsurance is the percentage you pay until you reach your out-of-pocket maximum. For example, if your out-of-pocket maximum is $5,000, and your coinsurance is 10%, you will pay 10% of all covered services after meeting your deductible until you have reached $5,000.
If you complete a Baseline Visit with Curative within 120 days as a member, you don’t have to worry about coinsurance because you’ll have no out-of-pocket costs for in-network services.
A copay is a fixed flat fee a patient pays their provider before receiving a health care service. Please note that in most instances, premiums and copays do not count toward your deductible. However, both are counted towards the plan's maximum out-of-pocket limit, the maximum the person will have to pay for their covered, in-network care during the plan year. If you complete a Baseline Visit with Curative within 120 days as a member, there are no copays for all in-network services, so you never have to worry about the cost of a visit!
An out-of-pocket maximum is the most you will pay for your medical services in a year. This includes your deductible, copays, and coinsurance. You want to be sure that your plan has an out-of-pocket maximum to reduce financial burden. If you were to have a medically catastrophic event, you want to know that you will only have to pay a set amount out-of-pocket and that your health insurance company will pay the rest. With Curative, employees who have completed a Baseline Visit will pay $0 for comprehensive in-network services.
Type of Plan
Health Maintenance Organization (HMO)
HMOs often include lower premiums, deductibles, and out-of-pocket costs. However, the downside is that you must pay the full cost of care yourself to see providers outside the network. There are exceptions for emergencies and if you need care that isn’t available in the network. You also must have a referral from your primary care physician to see a specialist.
High Deductible Plan
High Deductible Health Plans are typically paired with a Health Savings Account (HSA), which allows you to save pre-tax dollars to save for medical expenses. These plans offer lower premiums and access to preventative care without meeting the deductible, but they also include high deductible costs in the case of emergencies and non-preventative care. There are also restrictions on how HSA funds can be used.
Exclusive Provider Organization (EPO)
An EPO is a managed care plan where your health services are covered if you use in-network physicians and providers. There are no out-of-network benefits except in an emergency or if you need care that isn’t available in the network. EPO plans usually don’t require you to have a primary care physician. You also don’t need a referral to go to a specialist.
Point of Service Plan (POS)
A POS is a managed care plan that that usually requires you to select a primary care physician from within the health care network while retaining network flexibility. With a POS, you can access in-network and out-of-network services, paying a higher rate for out-of-network services.
Preferred Provider Organization (PPO)
This type of health plan allows you to see any provider and a specialist without a referral. This plan also offers a reduced cost for visiting providers within the plan’s network.. However, PPOs often include higher premiums, deductibles, and out-of-pocket costs. Curative’s health insurance plan operates as a PPO. If you complete a Baseline Visit with Curative within 120 days as a member, there are no copays, deductibles or coinsurance for all in-network services.
Which Providers are In-Network
If you want to maximize your health insurance plan, you may want to consider reviewing your health insurance company’s provider network. If a provider is out-of-network, the physician does not have a contract with your health insurance plan provider. Seeking care from an out-of-network provider may result in higher out-of-pocket costs for services. It’s essential to determine if your preferred providers are in-network.
Curative’s comprehensive network includes many providers, facilities, and pharmacies in Texas, coupled with a large national network in partnership with First Health.
*Health care provided through the NormanMD network of medical providers. Treatment options and eligibility determinations made by independent licensed medical providers.
Coinsurance is confusing, we know. We break it down step by step in our infographic.
Healthier workforces don’t just happen by treating what’s wrong— but by helping employees gain greater control of their own health and wellbeing. When health care is this easy, it helps employees feel healthy, resilient, and engaged. For more information on Curative, our new health plan, and our vision for the future of health care, please visit: curative.com. You can also to refer your employer to Curative here.
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