Student: Want to understand Health insurance terms?

• What benefits should I take in any insurance plan?
• Is annual Check up free?
• Is copay compulsory?
• What is deductible?
• What is Coinsurance?
• What is Out of pocket?
• What benefits should I take in any insurance plan?

1. We should first call the insurance company and ask them about the benefits in detail.
2. If you have any vision or dental related issues then it is recommended to apply for these add-ons.
3. Pregnancy plans are extremely good in the USA. According to the plan, talk to customer care.

• Is annual Check up free?

Yes. This is definitely free for everyone, one time in a calendar year.

Note: If you have Aetna for six months and for the next 6 months you have united health care then you cannot do an annual free check two times with different insurance companies. (Make sure your calendar year is different every time you do an annual check-up)

• What is copay and Is it mandatory to pay?

1. The copay is a fixed amount you pay for a health service, such as a doctor’s appointment or a prescription. The amount of the copay depends on your health plan.
2. If you see the above picture,

• If it is a normal doctor's office visit then I have to pay a 25$ copay.
• If it is a Speciality doctor's office visit then I have to pay a 75$ copay.
• If it is an Emergency room visit then I have to pay 300$ copay.
• What is deductible?

1. A deductible is an amount you pay each year for most eligible medical services or medications before your health plan begins to share in the cost of covered services.
2. For example, if you have a $2,000 yearly deductible, you’ll need to pay the first $2,000 of your total eligible medical costs before your plan helps to pay.

• What is Coinsurance?

1. Coinsurance is a portion of the medical cost you pay after your deductible has been met. Coinsurance is a way of saying that you and your insurance carrier each pay a share of eligible costs that add up to 100 percent.
2. For example, if your coinsurance is 20 percent, you pay 20 percent of the cost of your covered medical bills. Your health insurance plan will pay the other 80 percent. If you meet your annual deductible in June and need an MRI in July, it is covered by coinsurance. If the covered charges for an MRI are $2,000 and your coinsurance is 20 percent, you need to pay $400 ($2,000 x 20%). Your insurance company or health plan pays the other $1,600. The higher your coinsurance percentage, the higher your share of the cost is. You are also responsible for any charges that are not covered by the health plan, such as charges that exceed the plan’s Maximum Reimbursable Charge.

• What is Out of pocket?

1. The out-of-pocket maximum is the most you could pay for covered medical expenses in a year. This amount includes money you spend on deductibles, copays, and coinsurance. Once you reach your annual out-of-pocket maximum, your health plan will pay your covered medical and prescription costs for the rest of the year.
2. For example. You have a plan with a $3,000 annual deductible and 20% coinsurance with a $6,350 out-of-pocket maximum. You haven’t had any medical expenses all year, but then you need surgery and a few days in the hospital. That hospital bill might be $150,000.
3. You will pay the first $3,000 of your hospital bill as your deductible. Then, your coinsurance kicks in. The health plan pays 80% of your covered medical expenses. You’ll be responsible for payment of 20% of those expenses until the remaining $3,350 of your annual $6,350 out-of-pocket maximum is met. Then, the plan covers 100% of your remaining eligible medical expenses for that calendar year.
4. Depending on your plan, the numbers will vary — but you get the idea. In this scenario, your $6,350 out-of-pocket maximum is much less than a $150,000 hospital bill!

Important Notes:

• Make sure your copay is less.
• Deductible should be around 3000$.
• I am paying 140$ per month for my health insurance. (Single)
• Do not waste your free annual check-up.