When it comes time to explore your options for a health insurance plan for your family, your business, or just yourself, there can be a dizzying array of options. That’s a good and a bad thing. Here’s a good way to start simplifying things.
We typically group health insurance policies into two broad categories: Those that have office visit copays and those that don’t. The “copay” style policies obviously have doctor copays, drug cards, and typically have some kind of 80/20 or 70/30 “coinsurance” coverage after the deductible for a while. In other words, once you meet your deductible, the plan pays 70% or 80%, leaving you to cover the remainder until you reach your “out of pocket maximum,” which is usually $3-5k more.
The plans without copays leave you to pay for doctor visits against your deductible, though you do get discounted rates in the network (and most docs are in most major networks). Most similarly don’t have a drug card with prescription copays – instead you pay discounted rates against your deductible just like with an office visit. These plans do, however, typically give you 100% coverage after the deductible, so your overall exposure to risk (worst-case scenario) is less. Many of these also qualify you to put money aside tax-free in a health savings account (HSA) to help you fund these health-related expenses.
All major medical health insurance plans now include 100% coverage for preventive/wellness care, meaning you shouldn”t pay a dime for an annual physical, an OBGYN annual visit for a female, or for basic cancer screenings like a mammogram for women over 40.
Again, this is overly simplified. You can find exceptions to these rules all over the place, but hopefully this will help you begin to think about the kind of health insurance plan that you want. There are obviously personal circumstances to consider, including your budget, your medical history, and that sort of thing. We’d love to help you in this process, so contact us so we can help you figure this all out!
