When buying an individual insurance plan, we expect it to protect us from the worst case scenarios: a bad accident, a medical emergency, or another unforeseen health-related occurrence. None of us expect for these things to happen, but when they do, we need health insurance coverage. But when we're faced with outrageous out-of-pocket expenses, what exactly do individual insurance plans cover?
Depending on the type and category of the health insurance plan you purchase, you may find yourself paying less for your monthly premium payments but getting caught paying more out of pocket than you anticipated.
Different Types of Out-of-Pocket Expenses
When you buy an individual insurance plan, you buy a promise with your health insurance provider to share the cost of your medical bills. How much you spend per month on these plans determines how much more your insurance provider will cover and how much less you'll have to pay.
There are four types of cost-sharing expenses:
1. Deductible: the amount you pay every year before the insurance company starts paying its share (Ex. If your deductible is $1,000, then you will have to pay the first $1,000 of medical fees before insurance will help subsidize the cost for you.).
2. Copay: the fixed amount you pay for certain types of care (Ex. Visiting a specialist may cost a copay of $50). Generally, the more you pay in premiums, the lower copays are.
3. Coinsurance: the percentage of cost for your medical care that you have to pay (Ex. If your MRI screening costs $1,000, you might have to pay 30 percent, or $300, out of pocket, while your insurance provider covers the 70 percent.)
4. Out-of-Pocket Limit: after paying for all of the previously mentioned expenses, you will reach this limit. The insurance company will then pay 100 percent of your costs for the remainder of the year.
Depending on the type of plan you purchase (Bronze, Silver, Gold, or Platinum), the amount you pay out of pocket will vary. That's why it's important to know how you will use your insurance plan and how often.
At HealthMarkets, we will help you find the right individual health insurance plan to fit your lifestyle. We'll compare from Bronze to Platinum to see which would suit your needs and your budget.