Learning to Read Your Health Insurance Summary of Benefits | How to Insurance | 054
Hi, I’m Peter!
Welcome to HOW TO INSURANCE
Helping YOU understand insurance,
building CONFIDENCE for your future!
Have you ever tried to read your health insurance summary of benefits?
It can be very overwhelming and a little complicated.
So, let me break it down for you and point out the most important parts that most people are concerned about.
Today we are talking about:
Learning to Read Your Health Insurance Summary of Benefits
So, if you have health insurance or are looking to find some, every policy will have what’s officially called the Summary of Benefits and Coverage.
These numbers and costs are standardized and government regulated, which is why they all look the same. However, you need to read the fine print and understand it.
The Summary of Benefits and Coverage explains:
How much you pay if you go to the doctor
What you’re on the hook for if you ride in an ambulance
The maximum amount you’ll have to pay for the worst-case scenario
Those are all important things to understand.
You don’t want surprises.
Especially not financial surprises.
So, it’s time to be informed and know what you’ll pay and when… with your health insurance plan!
Let me make it simple and break it down for you:
The 5 Most Common Costs to Understand
1. Premium
This is the amount the health plan costs each month.
Now, you’ll often see two different figures… one is the full price premium (what the plan actually costs and the other is the price that you pay (after any tax credits or employer financial help)
The premium is paid monthly.
You always pay for the next/future month.
Even though you pay these expenses, they don't count toward the out-of-pocket
limit.
If you stop paying this monthly premium, your health insurance will be canceled. So don’t stop paying! :)
2. Co-Pays
This is how much you pay when you go to see a doctor, see a specialist or get a procedure.
It’s generally $5 - 95 depending on your plan.
Check your co-pay and be prepared to swipe that card when you check in at the doctor’s office.
3. Deductibles
The deductible is a large amount of money (usually $4,000 for a Silver plan) that you may have to start paying if you have a major medical expense.
For example, most plans have to start paying the deductible if you’re hospitalized.
However, if you have a Gold or Platinum plan, there is usually a $0 deductible.
Generally, you must pay all of the costs from providers up to the deductible amount before this plan begins to pay.
If you have other family members on the plan, each family member must meet their own individual deductible until the total amount of deductible expenses paid by all family members meets the overall family deductible.
4. Co-Insurance
This is the percentage that you pay for things.
So if it says you have a 30% co-insurance and the bill is $1,000, then you pay $300.
Typically, you only have a co-insurance for large expenses and hospitalization (except on some Bronze plans where you pay this up front)
5. Out-Of-Pocket Maximum
This is your financial backstop!
This is the most that you’ll have to pay all year.
It’s a calendar year, annual, out-of-pocket maximum. So once you hit this amount you aren’t financially liable for more charges.
Let’s just hope you don’t hit this amount!
But if you do… it’s a lot better than having to pay $50,000 or $250,000 of medical expenses~
Do You Need Health Insurance?
So, now is the time!
You can START a new health insurance plan during Open Enrollment, November 1 - December 15.
Contact me for help and I’ll make it simple, save you time and complete your health application!
In Washington State, we’ll use wahealthplanfinder.org
In Oregon, we’ll apply through Healthsherpa (which coordinates with healthcare.gov and makes it easy)
In California, we’ll apply through CoveredCA.com and I’ll complete the application for you in one day.
Next Steps:
Contact your trusted independent insurance broker.
Start, Renew or Change your Healthcare Plan for 2021
If you’d like to just take a look at what plans are available to you, you can Shop and Compare here:
I look forward to hearing from you!
At Apple Insurance Solutions,
We all want to protect what matters most to us in life,
but finding the right insurance can be confusing.
So I make it simple.
As Your Insurance Broker,
All your insurance is covered in one relationship,
saving you time and
building confidence for your future.
If this was helpful to you, please:
“Like and Share” this post
Follow me on social media (@appleinsurancesolutions)
Contact me at peter@appleinsurancesolutions.com
Also, keep in mind, that as Your Insurance Broker,
I offer insurance for auto, home, life, health, medicare, umbrella, and business… when you work with me, all your insurance needs... are in one relationship.
Thank you for reading HOW TO INSURANCE
Helping YOU understand insurance,
building CONFIDENCE for your future!
PETER D JOHNSEN
Insurance Broker | Apple Insurance Solutions
360.818.4865 OR/WA 818.620.8171 CA
Auto | Home | Life | Health | Medicare | Umbrella
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