Design Your Utah Health Insurance Policy

There are several important factors in your health insurance policy that can result in cost savings for you-if you know what you and your family need. Some insurance companies allow you to choose from various options on these items. You should also try to assure that you can make changes in the future in case your needs or budget changes.

DEDUCTIBLES

A deductible is the amount of covered medical charges you must pay on your own before your policy begins to pay benefits. Generally, the higher the deductible, the lower your insurance premiums.

Many policies have a wide range of deductibles available, especially for the hospital portion of your coverage. Deductibles may range from $200, to $1000, all the way up to $10,000 or $25,000.

If you are trying to keep your insurance premiums low, while still protecting yourself from catastrophic medical expenses-the kind that could run into hundreds of thousands of dollars and force you to sell your home and other assets-you will probably want to keep your deductible fairly high. By selecting a higher deductible, your regular insurance premium payment will be lower. This would mean your out of pocket expenses would e higher if you do have an illness or injury, but you have saved money each month through lower premiums.

COINSURANCE

A coinsurance is the percentage of covered medical expenses you pay out of your own pocket after you have met your policy deductible.

While policies are available which pay 100% of covered charges, these are quite expensive. People who are more concerned with their budget have tended to look toward policies with coinsurance Probably the most popular coinsurance option available on many policies today is the 80/20 type plan.

With an 80/20 plan, after you have met your policy deductible, you pay 20% of the covered medical charges and the insurance company pays 80%.

There are other configurations of the co-payment available. Many companies offer 70/30 or 50/50 type plans. As the second number increases, it means you pay a larger percentage of the covered expenses. ?Please Keep in mind as with a PPO Plan your Coinsurance is different when you are in network and when you are out of network. While you may want to consider this type of policy when you realize how much you can save in regular insurance premium payments.

STOP-LOSS POINT

Before you make a decision on the coinsurance amount you can afford to accept, you need to determine if the policy you are considering has a “stop-loss” point. This means for your policy type, the insurance company has structured it to stop your losses at a certain level of covered expenses.

For example, if the policy has a $5000 stop-loss, you pay your payment percentage only up to $5000 stop-loss, you pay your CO-payment percentage only up to$5000 of covered medical expenses. Once your covered expenses have reached $5000, the insurance company pays benefits on all other covered expenses, up tot the maximum amount of your policy.

Some insurance companies allow you to select from various stop-loss points so that you can better control what your maximum out-of-pocket expenses might be.

OUTPATIENT EXPENSES

It is not uncommon in today’s medical world with if a individual has a catastrophic illness for the some or even the majority of treatment to be handled as an outpatient. We fervently believe that it is in your best interest to have your outpatient expenses be built into the plan.

OUT-OF-POCKET COSTS

There are really three levels of out-of pocket costs you need to look at when you are considering what you wish to select in terms of deductibles, coinsurance and, co-payments .

First, you want to review what your average or general medical expenses have been in recent years and what you think they reasonably may be for the near future. For example, if you have children and you expect to have numerous outpatient expenses for minor ailments, broken bones, etc., you need to weigh this against the amount you will pay in premiums to have even minor doctors’ office visits covered by your insurance. In many cases, if you can handle the runny noses and other minor occurrences on your own, you can save money in the long run through lower insurance premiums. Or look for a plan with Doctor Visit CO-payments

Second, you need to think about how much you could reasonably cover yourself if you had serious medical expenses to contend with. For example, if you or one of your covered family members had a car accident and required extensive hospitalization, how much could you pull in from savings, how much could you cover by using a credit card, how much could you defer to a payment plan without drastically altering your own lifestyle?

These are not easy questions, nor are there any “right” answers to them. But in order to have more control over your own budget and your health insurance, you need to review them.

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