Health Insurance

Health Insurance 101: Intro to Networks

Hey Guys! Quick recap on what you should already know before we hit the ground running on NETWORKS. 

There are three essential components you should know and feel comfortable with when selecting a health insurance plan:

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.

Networks: the doctors and hospitals that will be covered and will “accept” your insurance plan, or in simplified terms, who you can see for less $$$.

Like I said… it’s very important that you review the network of doctors and hospitals included in the health insurance plan to make sure it includes the doctors you want to see.

Let me give you an example that I went through when selecting my dental plan…

My dentist is Dr. Ted and I’ve been going to him for years. Dr. Ted is the BEST dentist around- he’s friendly, he’s funny, he’s motivated by helping people, and heck I’ve never gotten a cavity (knock on wood!) Now when I started a new job and had to select my dental plan I had two options- HMO or PPO. So what did I do? I checked to see if Dr. Ted was in both networks. PPO networks are typically much larger than HMO networks and it turns out that Dr. Ted is in the PPO network but not the HMO network. Conclusion made– I’m selecting the PPO because for me I would rather pay more money for the PPO and get the high-value service from my current dentist who knows my teeth well.

The same applies to any plan you select, whether health insurance, dental, or vision insurance!

Make sure your doctors are -in network-

Now, this doesn’t limit you from seeing doctors who are “out-of-network”. Most of those doctors will still see you but if you are in an HMO you typically become a cash-paying patient where you have to pay for all services by yourself (“out-of-pocket”- remember that term??) with no help from the insurance plan you are currently paying for. If you are in a PPO the insurance may still cover some of it but it will be much more expensive than seeing an “in-network” provider.

Any questions on NETWORKS? Feel free to comment below and I look forward to seeing you next time when we chat about BENEFITS!

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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