Understanding Your Insurance Plan
It’s important to understand the type of health insurance you have before you go see a doctor so you are aware of what providers you can see and if there are any out-of-pocket expenses that may be required for the health care services you will be receiving.
TIP: Have your insurance card available when you contact a doctor's office to make an appointment
What Is My Insurance Plan?
Health insurance plans that are provided to you through your job or by purchasing them directly through an insurance company (ex: Aetna, Blue Cross Blue Shield, Cigna, etc).
How Do I Know Which Type of Commercial Plan I Have?:
- PPO (Preferred Provider Organization) - has lower co-payments but gives you more flexibility in selecting a provider
- HDPD (High-Deductible Health Plan) - has a higher deductible than most health plans, but it has a lower monthly premium
- HMO (Health Maintenance Organization) - has lower co-payments and covers the costs of more preventive care, but your choice of health care providers is limited to those who are part of the plan
You have this type of insurance if you purchased your plan through healthcare.gov
Key Insurance Terms You Should Know
Confirm these details prior to setting your doctor's appointment
TIP: Have the doctor's office verify your coverage prior to setting your appointment or contact the insurance company directly.
- Co-Pay: what you pay each time you visit a provider. Visits to PCPs usually cost less than specialists.
- Coinsurance: The percentage of medical costs you'll have to pay after you reach your deductible – ex: if your coinsurance is 20% and your doctor visit is $100, you will be liable for paying $20 for your visit.
- Deductible: annual amount you'll have to pay out-of-pocket for your medical expenses before the insurance company begins to pay claims – if you have not reached your deductible amount for the year, you will have to pay for health care services.
- HSA (Health Savings Account): an extra feature of your insurance plan in which you contribute pre-tax money to this account to go toward your healthcare expenses; you should always check the available funds in your HSA prior to making a doctor’s appointment.