Butler Health System | Butler Health | Fall 2018

What’s your health insurance IQ? Know the lingo Sometimes, health insurance policies feel like they’re written in a foreign language. You read them and wonder, “What in the world does that mean?” Understanding basic medical insurance terms is important—especially if you’re shopping for a new policy. That knowledge can help you pick the plan that best fits your needs and may save you money. Healthcare.gov provides plain-language defini- tions of many health insurance terms. You’ll find a list of terms at healthcare.gov/glossary . You can also read definitions of some basic terms below. • Premium. The monthly amount you pay for insurance. • Coverage. The health services your plan will pay for. • Deductible. The amount you’re required to pay for medical care each year before your insurance begins to pay. If you have a deductible of $1,000, you’ll pay $1,000 out of pocket for covered health services before your insurance pays anything. The deductible may not apply to all services. • Co-pay. This is short for co-payment. It’s a set dollar amount ($15, for example) you pay each time you see a provider, get a prescription or use another covered health service. Your co-pay can vary, de- pending on your plan and the type of service you get. Your insurance company pays the rest of the bill, up to the amount allowed by your plan. • Allowed amount. The most your plan will pay for certain health care services. If your health care provider charges more than your insurance will pay, you may have to pay the difference. • Co-insurance. The percentage of the cost of a service that you must pay after you’ve met your deductible. A common co-insurance ratio is 80-to- 20. In other words, insurance pays 80 percent of the allowed amount for the service and you pay 20 percent. • Formulary. A list of prescription drugs that your health plan or prescription plan will cover. It’s also called a drug list. • In-network/out-of-network. Providers— hospitals, doctors, specialists and therapists, for example—who accept your health insurance are called in-network providers. Ones that don’t are called out-of-network providers. It typically costs you more to see out-of-network providers, so check carefully to see if the health care providers you use or are considering using are in-network or out-of- network. Sources: AARP; Centers for Medicare & Medicaid Services Shopping for health insurance? Ask these 5 key questions Good health may be the most important thing anyone can possess. And good health insurance can play an important role in helping you achieve it. When selecting a plan, there’s a lot to consider—and cost shouldn’t be the only one. It’s also to your advantage to find coverage that meets your needs. Here’s a checklist of questions to ask yourself as you weigh your options: 1. Am I clear about what health services the plan will cover? Coverage can vary, and it’s important to know the specific details of different plans. Because of the Affordable Care Act, most traditional health care plans must cover the same basic services—such as preventive care, hospital care, mental health care and maternity care. But some services, like chiropractic, dental and vision care, may not be fully covered. In contrast, short-term health insurance plans—those that limit coverage to less than a year— aren’t required to be as comprehensive as standard ones. For example, short-term plans might not cover maternity or mental health care. And while all standard plans must cover pre-existing condi- tions, short-term ones might not cover them. 2. Will the plan cover all the medicines my doctor prescribes? Some may not. 3. Will I be able to keep my current doctor or hospital? Make sure they’re in your plan network. If not, see how much more you need to pay to see an out-of-network provider. 4. What are the premiums, co-pays and deductibles? Premiums are the amount you pay for health insurance, no matter what services you use. You might pay it monthly. Deductibles are what you must pay before your insurance company pays anything for a claim. Co-payments are what you pay when you receive a medical service or fill a prescription. 5. What is the most I’ll have to pay out of pocket? You may have to pay a certain amount before a plan starts to pay for your care. Sources: America’s Health Insurance Plans; Centers for Medicare & Medicaid Services; National Institutes of Health; USA.gov ButlerHealthSystem.org | 7