How does my Health Insurance deductible work?Your deductible is the amount you are responsible for before your insurance company begins to cover your healthcare expenses.  You may also have a co-pay (See what is co-insurance). The deductible is designed to keep premium costs down.  The higher deductible you choose the lower the monthly premium will be.  A good plan would credit out of pocket medical expenses throughout the year toward your deductible.  Lets say you had outpatient testing services like lab, x-rays, etc. leading up to a surgery.  These out of pocket costs would apply to your deductible for the year.  Be careful though, there are plans out there that do not credit these outpatient services toward your annual deductible.

Is there anything that will help pay for the Deductible and Co-insurance?  There is one major medical carrier that we work with that offers this kind of peace of mind.  Their plans feature an add on benefit called Suite Solutions which will pay you back all of your deductible and co-insurance (OOP Out of Pocket expense up to $10,000) for any accident or a critical illness (Life threatening cancer, Heart Attack, Stroke, Paralysis, Renal failure, Coma, Major organ transplants, loss of sight/.speech/hearing).  It includes an accident indemnity benefit and Accidental death and Dismemberment benefit and a weekly disability benefit up to $250.

Do you really need Office Visit Co-insurance?  Office visit co-insurance is a benefit that for many does not make good sense.  True it is nice to know that whenever you go to the doctor you will only pay a set fee, but you are paying for it in your monthly premium.  For families with young children or people with medical conditions it can make sense, but for most people in relatively good health it may not.  Ask yourself, how many times does your family normally go to the doctor in a given year?  Then ask, what is the difference in the monthly premium?  Lets say for example,  co-insurance for office visit on your policy is $35 and your family normally goes to the doctor about (4) times a year.  The difference in the premium on your health insurance is $100 a month, which means your paying $1200 plus the $35 co-insruance, equaling $1340 more per year for your health insurance.  If your family went to the doctors (4) times in a year and received a network discount, you might pay $75 for the office visit.  That would be $300 for the year; you would have saved $1040 in premium dollars without the office visit co-pay.

What is a Network Provider?  Many people are confused about network providers.  Some think their doctors will only accept certain insurance carriers.  They often ask the question, will my doctor take this insurance?  The answer is not who the insurance carrier is, but which network(s) your doctors & hospitals belong to. PPO Network providers have a contract agreement with Hospitals, Doctors, Laboratories, etc. This contractual relationship may establish standards of care, clinical protocols, and allowable charges for specific services.   In other words, a discount will be given off the normal cost of services.  This discount can vary from about 15% to 40% depending upon the Hospitals or Doctors you choose.  There are many different network providers throughout the U.S.; most are regional networks available only in certain states.  There are (2) national network providers, which means they have Hospitals, Doctors, labs, etc. throughout the country.  The cost of each network will vary and will be included in your monthly premium. 

What is a Facility Fee or Hospital admission fee? Some policies require 'facility Fees (also called 'service deductibles') or hospital admission fees for hospital stays and possibly for outpatient services.  This is a relatively small portion of the high cost of hospital and outpatient facility fess you must pay.  A good major medical plan will pay the remainder of the charges.  Be “aware” that many plans have limits of what they will pay daily for hospital charges.  This could leave you with additional unexpected costs for a lengthy hospital stay.  
 
What about Maternity benefits?  Maternity benefits may or may not be added to a plan depending upon the insurance carrier and the state you reside in.  However, this can be a very expensive addition to your plan.  Once again depending upon the state you reside in there are other services available that may be less costly in the long run.  In Calif. there is a government sponsored program called Aim (www.aim.ca.gov , (800) 433-2611) designed for women who are pregnant and have no maternity coverage.  For a one time fee based upon your income it will pay for all or most of the cost through delivery and will even cover the infant for period thereafter.  Other states have similar programs for moderate income families.