Health Insurance

Health Insurance 101- Intro to Benefits

Hey Guys and Gals! I’m sure you’ve been waiting in anticipation to learn more about BENEFITS!!

Before we get started, here is the quick recap of the three health insurance essentials so you can see where BENEFITS kicks in.

Three key essentials:

  • Cost Sharing
  • Benefits/Coverage
  • Networks

The gist: you need to find a health insurance plan that includes the BENEFITS, or medical services, that you need with the NETWORK of doctors and hospitals that you want to see with a COST SHARING setup that fits your budget.

Benefits/Coverage: which medical services you can receive that will be covered under the health insurance plan, or in simplified terms, what you get for your $$$.

Benefits that are covered in your insurance plan will range from who is providing the service (midwives, physical therapists, chiropractors, etc.) to where the service is provided (in the hospital vs outside the hospital in a clinic, skilled nursing facility, etc.) to how long the service can be provided (length of hospital stay for having a baby).

And where can you find all these details??

Summary of Benefits and Coverage– remember that document we talked about a couple weeks ago? This document, even though it looks incredibly daunting, is your best health insurance friend because it tells you what is covered and what it will cost! It will feel like reading the ingredients on a nutrition label or your prospectus when investing- it’s not exciting and there are going to be terms you won’t know but use Google and ask friends and read it because IT’S IMPORTANT! 

Key tip to remember: Your COST SHARING is directly related to the size of your BENEFITS and your NETWORK. If you need or want more BENEFITS to be covered by your health insurance plan, and potentially the option of a larger NETWORK of doctors and hospitals, your COST SHARING will go up accordingly.

More Benefits + Larger Network= Cost Sharing (1)

Now many of you have been asking me how to best take advantage of your benefits and my recommendation is this: Take advantage of your free annual preventive visit with your doctor. Most of you should have this with your insurance plan (or should select an insurance plan with one) and it’s important you use it!

Any question about BENEFITS? Comment below and as always…

Cheers to Health and Happiness!

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Health Insurance

The Three Essentials of Health Insurance

Hi Everyone!

Today is the special day everyone has been waiting for- to learn the key essentials that you need to know about picking your health insurance plan!

There are three key essentials:

  • Cost Sharing

  • Benefits/Coverage

  • Networks

I’ll touch on each of these briefly here but then we will go into more depth in each of the following episodes so be sure to follow along!

Here are the basics you should know and understand before we move on into the complexities:

Cost Sharing: the amount of money you must pay for medical care vs what the insurance company will pay. Cost sharing will differ both between health insurance plans and within the health insurance plan itself, for example, you may have to pay more for an emergency room visit than a clinic visit. We will get into more details in a separate episode but for now, think the $$$ you have to pay.

Benefits/Coverage: which medical services you can receive that will be covered under the health insurance plan. This ranges from who is providing the service (midwives, physical therapists, chiropractors, etc.) to where the service is provided (in the hospital vs outside the hospital in a clinic, skilled nursing facility, etc.) to how long the service can be provided (length of hospital stay for having a baby). We will get into more details in another episode but for now, think what you get for your $$$.

Networks: the doctors and hospitals that will be covered or who will “accept” the insurance plan. This doesn’t mean you can’t go to someone who is “out of network” but it means your insurance won’t cover it and you will need to pay all the medical bills yourself, what we call in the industry “pay out-of-pocket”. We will get into more details in another episode but for now, think who you can see for less $$$.

So here’s the gist: you need to find a health insurance plan that includes the BENEFITS, or medical services, that you need with the NETWORK of doctors and hospitals that you want to see with a COST SHARING setup that fits your budget.

Any questions on these three essentials of health insurance? Let me know in the comments below! Otherwise, I’ll see you in our next episodes where we delve into each of these in turn!

Cheers to Health and Happiness! 

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