Understanding the Health Insurance Quote and How It Affects You insert_chart Get a quote

Understanding the Health Insurance Quote

When you receive a health insurance quote, there are several factors that are taken into account. you have a lot of options, but rather than being helpful, this variety can complicate your search for the plan that's best for your family. HealthPlans.com makes this important decision easier by providing you with information about the plan options in your area. We work closely with you to understand your lifestyle, your healthcare needs, and your budget. This is especially helpful when you are looking for affordable health insurance that is not provided by your employer.

What the Insurance Quote Represents

Our role is to help you understand the pros and cons as you compare quotes, so you are confident that you have the premiums and coverage that are most beneficial to you and your family. With that in mind, it's important that you understand how plans work. This understanding often starts with answers to some of the most common questions regarding insurance plans:

If you qualify for assistance, such as tax subsidies, your choices will also be affected by the plans offered through your state and federal marketplaces. The more you know about how insurance works, the better you can recognize insurance coverage that's appropriate for you and your family.

Yearly Deductibles and Copays

Deductibles are the amount you pay out of pocket before your insurance coverage kicks in. Usually, this is a predetermined amount that varies based on the policy, your health needs, and your monthly premiums. Plans with higher monthly premiums tend to have lower deductible costs and vice versa. Copays usually don't count toward your deductible. If you have a family, your plan may have two deductibles: one for the family as a whole and an individual deductible for each person. Once you reach your deductible, the rest of your costs should be covered for the year. These out-of-pocket payments reset each year.

Doctors and In-Network Status

Many insurance plans offer you lower costs when you work with an in-network doctor, and if you want to stick with your existing doctor, it's important to check whether the new insurance is accepted before making a switch. However, your doctor may accept the insurance without being in-network.

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If you have used any type of health insurance in the past, you've probably experienced coinsurance even if you didn't realize it. In many plans, after you've met the deductible, you and the insurance provider split the rest of the medical costs. For example, the insurance may cover 80% of an emergency room visit while you are responsible for the remaining 20%. Many policies have different percentage rates for various types of services. For example, preventative care may be covered fully, but a visit to a specialist may only be covered at 70%. Prescription drugs are generally covered at different percentages, often dependent upon the type of medication.

When manufacturers first set their prices for drugs, they consider the research, availability, and any existing patents for the medication. From this point, wholesale providers, pharmacy benefits managers, and insurance companies negotiate the price that patients will pay. Insurance companies and pharmacies plan their own formularies (or lists of covered drugs.) Sometimes, insurance companies have preferred pharmacies, and patients will save on drug costs when making their purchases at those designated pharmacies.

When you have a medical emergency, you probably aren't thinking much about your insurance coverage, but there are many factors that could affect how much you end up paying. For example, if your injuries are treated by a doctor at a hospital and both are within your network, you may end up paying less than if you were out of network. Unfortunately, medical emergencies may happen when you're at work or while on vacation. Some insurance providers require you to get preapproval from an in-network provider before receiving services that are out of network. Finally, the severity of the symptoms that lead to an emergency room visit could affect coverage.

For many people, the out-of-pocket costs are what really define affordable health insurance. these are any expenses you have for medical care that your insurance company doesn't cover. This includes deductibles, copays, and your percentage of the coinsurance. It doesn't include the monthly premium, but this amount should be factored in as you compare quotes.

Personal Circumstances

Once you understand how these areas figure into your final cost, you must also consider your own unique circumstances.

Any one of these situations, as well as many others not listed, could affect whether one insurance plan is better for you than another. You'll need help determining how an existing plan could be affected by your unique situation.