This column appears in the Nevada Appeal Wednesday health pages. It addresses topics related to the health of our community.
Health Insurance is now required for every American, but most people still are confused by the process and what different terms mean. Last week, we covered different types of plans that are available. Today, we’ll explore the levels of plans offered on the health exchange, and the meaning of some common, but confusing health insurance terms that can have a big impact on the out of pocket costs of your health plan so you can be well-informed to sign up for a new plan before open enrollment ends on Jan. 31.
Everyone wants to receive the best possible care. When people are shopping for health insurance on the Nevada Exchange, and see the different levels of plans available — Bronze, Silver, Gold and Platinum — many are confused and concerned the level they choose corresponds to the quality of care they receive.
These levels don’t correspond to the quality of care you’ll get, but they do describe the way costs are shared between you and the insurance company. The categories are based on how you and the plan split the costs of your health care. Generally, plans in the bronze category have the lowest monthly premiums, but the highest deductibles and other out-of-pocket costs. A bronze plan is probably not a good choice for someone who receivs a lot of care, but might be right for a person who visits the doctor infrequently. Conversely, platinum plans have the highest monthly premiums, but lower deductibles and less out-of-pocket costs. For those who need to utilize health care services frequently, the cost of a platinum plan may be less overall.
When deciding on a plan, think about what your usage of the healthcare system is going to be. Are you healthy and use little? Do you have a few medical problems and seek care from a primary care provider only? Do you have multiple healthcare problems, seek care from specialists, and require medications? Do you anticipate any surgeries? These questions may help you decide on a plan that’s best for you. The out-of-pocket costs to you are multi-dimensional.
See below definitions:
Premiums: This is your monthly “bill” for health insurance. For some people with qualifying incomes, there’s help to cover this cost. In general, the lower your monthly premium, the more you’ll pay out of your pocket each time you get care. The opposite is usually true too: The higher your monthly premium, the less you’ll pay when you get care. Depending on how much care you expect to use, a plan with a higher monthly premium may cost you less in the long run.
Deductible: This is the amount of money you have to spend for covered health services before your insurance company pays anything. Some services may be covered before you reach your deductible, such as annual visits or free preventive services. Check your plan to see what screenings, immunizations and other services are covered. Typically, a plan with a lower monthly premium cost will have higher deductible requirements.
Copay: This is a fixed amount you pay for a health care service, usually at the time of service. The amount of your copay is set by your plan, and may vary for different types of service. For example, you may have a $30 copay for a visit to your primary doctor, and larger copays to see a specialist or visit the emergency room. If you visit your doctor or pharmacy often, look for a plan that has a low copay for office visits and prescriptions.
Coinsurance: This is your share of the cost of health care after you’ve met your deductible. Coinsurance is usually a percentage of the total cost of the service you received. As with deductibles, the lower a plan’s monthly premium, the more you’ll pay in coinsurance.
Aside from resolving to understand health insurance better, you might have some other New Year’s Resolutions for 2016. Is 2016 the year you quit smoking? Do you have a plan to lose weight, eat better, or be more active? Over the coming weeks, we’ll explore strategies to help you be successful with your New Year’s Resolutions. In the meantime, visit us on Facebook at www.Facebook.com/CCHHS and share your resolutions with us.
For more information about other health department services, follow us on Facebook or visit our web page at www.gethealthycarsoncity.org.