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12 Questions You May Be Afraid to Ask About Health Insurance

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Health insurance can be a confusing and intimidating topic, but it doesn’t have to be. Knowing the answers to these 12 questions can help you make smart decisions about your health care coverage. 

  1. What is the difference between an HMO and a PPO? 

An HMO (Health Maintenance Organization) is the type of insurance plan requiring members to receive care from a network of providers. A PPO (Preferred Provider Organization) is the type of insurance plan that allows members to receive care from both in-network and out-of-network providers, but typically at a higher cost for out-of-network care. 

  1. What is a deductible? 

A deductible is the amount a person must pay out-of-pocket for health care coverage before their health insurance plan begins to pay for the costs. Deductibles can vary widely depending on the type of plan, and they are typically paid at the time of service or when a bill is received. In some cases, deductibles may be waived if certain criteria are met. For example, some plans may waive the deductible for preventive care services. 

  1. What is a lifetime maximum? 

A Lifetime Maximum is a limit on the total amount of money an insurance company will pay for health care services over the course of an individual’s lifetime. This limit is usually expressed in a dollar amount, such as $2 million or $5 million. Once this maximum has been reached, the insurance company will no longer cover any additional medical expenses incurred by the insured person. 

  1. What are coinsurance and copayments? 

Coinsurance and copayments are two types of cost-sharing requirements that may be included in a health plan. Coinsurance is a percentage of the full cost of a medical service or prescription drug that the insured person must pay out-of-pocket. For example, if an insurance plan has 80/20 coinsurance, the insured person would pay 20% of the total cost while the insurance company would pay the remaining 80%. Copayments are a fixed dollar amount the insured person must pay for each medical service or prescription drug.

  1. What is an out-of-pocket maximum? 

An out-of-pocket maximum is the most you will have to pay for covered medical expenses in a year. Once you reach your out-of-pocket maximum, your health care plan will cover your remaining eligible medical costs for the remainder of the year. 

  1. How does cost-sharing work? 

An annual physical is a comprehensive checkup that includes a review of your medical history, physical exam, and laboratory tests. It is recommended that you have an annual physical to help detect any potential problems early on. 

  1. What is an exclusionary period? 

An exclusionary period is a set amount of time during which an individual cannot receive certain benefits from their health coverage. This period typically applies to those who have recently enrolled in a new health insurance plan and are waiting for coverage to begin. During the exclusionary period, the insurance plan will not cover any medical services related to pre-existing conditions or other excluded services. The length of the exclusionary period varies depending on the insurance plan. 

  1. What is a pre-existing condition? 

A pre-existing condition is a medical condition that has already existed before an individual’s health insurance coverage began. This could include any medical condition, illness, or injury that was diagnosed or treated prior to the start of the policy. Pre-existing conditions can range from minor ailments, such as allergies, to more severe conditions, such as cancer. Insurance companies often exclude coverage for pre-existing conditions, so it is essential to understand the terms of your policy before signing up. 

  1. What is an open enrollment period? 

An open enrollment period is a set time during which individuals can sign up for health insurance coverage. During this period, individuals can shop for different plans and compare their options. Open enrollment periods are typically offered once a year, but some states may offer additional open enrollment periods throughout the year. 

  1. What is a Health Savings Account (HSA)? 

A Health Savings Account (HSA) is a tax-advantaged savings account that allows people to set aside money for medical expenses. Funds in an HSA can be used to pay for qualified medical expenses, including doctor visits, prescription drugs, and other health care costs. HSAs are available to individuals enrolled in a high-deductible health plan (HDHP). Contributions to an

HSA are tax-deductible, and the funds can be withdrawn tax-free for qualified medical expenses. 

  1. What is a provider network? 

A provider network is a group of healthcare providers that aim to provide services to members of a particular insurance plan at discounted rates. When choosing a health insurance plan, it is crucial to ensure that it includes providers in your area that you are comfortable with. 

  1. What is an out-of-network provider? 

An out-of-network provider is a healthcare provider that does not have an agreement with your insurance plan to provide services at discounted rates. If you receive care from an out-of-network provider, you may be responsible for paying the service’s total cost. 

Key Takeaways 

When it comes to health insurance, there are a few key takeaways that everyone should keep in mind. First and foremost, having insurance is essential for protecting yourself and your family from unexpected medical costs. It’s crucial to understand the different types of health care coverage available and make sure you have the right plan for your needs. Additionally, you must be aware of any changes to your plan, such as open enrollment periods or provider networks. Finally, it’s essential to understand the terms of your policy and any exclusions for pre-existing conditions. 

Final Thoughts 

Health insurance is integral to protecting yourself and your family from unexpected medical costs. It’s essential to understand the different types of coverage available, be aware of any changes to your plan, and understand the terms of your policy. In addition, it’s vital to be aware of any exclusions for pre-existing conditions that may be included in your policy. By taking the time to understand these key points, you can ensure that you have the right insurance plan for your needs. 

At Insurance Enterprise, we understand the importance of getting the right health insurance plan for your needs. Don’t wait – take advantage of our open enrollment period and explore our plans today! Contact our amazing team of licensed agents today at 786-269-2520.