Content provided by the Health & Wellness Team at GBS Benefits
Understanding and feeling empowered to make confident healthcare decisions can be scary. However, not being properly educated or prepared is scarier. Take small steps to better comprehend your personal healthcare plan to make informed decisions, save money, and prepare for the unexpected.
Understand Key Health Insurance Terms
Let’s start with the basics. Review the following terms to gain a better understanding of your insurance plan. Insurance plans can differ in which providers you can see and how much you will pay. It’s important to understand your costs and key health insurance terms so you’ll know what services your plan will pay for and how much each visit or medication will cost.
- Premium: The amount you pay for your health insurance each month.
- Deductible: The amount you owe for covered healthcare services before your health insurance or plan begins to pay.
- Coinsurance: This is the percentage of the cost you pay for a covered healthcare service after you have met your deductible.
- Copayment: This is a fixed fee you pay for doctor visits, prescriptions, and other types of medical care.
- Open Enrollment: A window of time once a year when you can sign up for health insurance, adjust your current plan, or cancel your plan. It’s usually limited to a few weeks. If you miss it, you may have to wait until the next open enrollment period to make any changes.
- Qualifying Life Event: A change in your situation that can make you eligible to enroll in health insurance outside the yearly open enrollment period. Some qualifying events include getting married, having a baby, or losing health coverage.
- Network: The doctors, hospitals, and suppliers your health insurer has contracted with to deliver healthcare services to their members
Review the Benefit Guide
The benefit guide outlines what healthcare coverage is available to you. Reviewing the benefit guide will help you answer questions such as:
- What is your deductible?
- What is your out-of-pocket maximum?
- What are your in-network provider options, and are there discounts available?
- If you are on a high deductible plan, does it contribute to an HSA?
It’s important to have a basic understanding of these benefits to make better informed decisions for your healthcare needs.
Make the Most of Open Enrollment
Before you choose a health insurance plan, consider the following:
- How much did you spend on healthcare last year (including your premium, deductible, and out-of-pocket costs)?
- Did the amount you/your family spent line up with your healthcare needs?
- Is your doctor/clinic in network?
- Are your medications covered?
Stay Current with Preventive Care
A great way to take advantage of your healthcare benefits is utilizing preventive care visits and screenings. Preventive care is provided during an annual well check or general preventive screening with your primary care provider. You and your provider will determine what screenings are appropriate for you based on your age, gender, health history, and current health status.
Most health plans cover preventive care at 100%, meaning there is no cost to you if you are receiving care from a provider within your network. If you receive additional screenings or tests associated with a health issue, even at the same time as your preventive visit, these are billed separately, and you may be responsible for a portion of the cost depending on your individual plan.
Remember, you are the consumer and should feel empowered to question the services provided to you. Don’t be afraid to ask why a test or screening is necessary or if there are less expensive options for services, medications, etc.