November 22, 2024
Choosing a health insurance plan is an important decision. Like you would with other big purchases, be sure to compare how much you will pay and the value of what you’ll get in return.
When you’re shopping for a health plan, the “price tag” you see is the monthly premium. This is the amount you will pay to your health insurance company to keep your coverage active. But that is only the cost to buy the health plan. What will it cost you when you use your benefits, and will you have access to high-quality care?
Here are other factors to consider in addition to the monthly premium:
• Are your favorite doctors and hospitals in the network?
• What services and prescription drugs are covered (or not covered)?
• How much will your health insurance company pay when you receive covered services?
• How much are you responsible to pay out of your own pocket for things like doctor visits, prescription drugs, and hospital stays?
• Does your health plan have a deductible, how high it is, and which services does it apply to?
With all these factors to consider, how can you decide which health plan works best for you?
To get started, it’s important to become familiar with these common cost-related health insurance terms:
• Cost-sharing– Cost-sharing refers to the amount of money you pay out-of-pocket for health care services. Cost-sharing may include copayments, coinsurance, and deductibles.
• Copayment– A copayment (or copay) is a set amount you pay for a covered health care service. Your copay is typically due when you receive the health care service, and the amount will be different for different services. For example, the copay for seeing your primary care physician may be different from your copay for an emergency room visit.
• Coinsurance– Coinsurance is the percentage you pay out-of-pocket for some covered health care services. For example, if your coinsurance for radiology services is 20%, your health insurance company pays 80% of the cost, and you pay the remaining 20%.
• Deductible – A deductible is the amount of money you pay out-of-pocket for health care services before your health insurance company starts paying some or all of the costs. Every health plan has different deductibles, and a deductible may only apply to some services and not others.
As you’re shopping, refer to the Summary of Benefits for each health plan to see what cost-sharing applies. The Summary of Benefits is a detailed chart that shows all the services the health plan covers and your out-of-pocket costs for each service.
The simple answer: Usually.
Be sure to look at what out-of-pocket costs you’ll pay when you receive services. You’ll also want to think about how much you anticipate using your benefits. If you expect to use health care services frequently in the plan year, you may want to pick a plan with a higher premium so you can pay less for each service. But if you are not someone who uses health care services often, it may be more affordable to choose a lower-premium plan.
With the largest network of doctors and hospitals in the region, no other health insurance company knows Philly like Independence Blue Cross (IBX). And we’re the only health insurance carrier in the area that has continuously offered coverage for individuals and families since the start of the Affordable Care Act.
Our 2025 options include health plans with no deductible. IBX offers the widest selection so you can find an affordable health plan that works for your personal health, budget, and preferences. If you need help finding the right health plan, IBX is here for you! Call 1‑888‑475‑6206 (TTY: 711) to speak to a licensed agent.
With comprehensive coverage like ours, you have access to the care and support you need.
Learn more about choosing the right health plan.
This content was originally published on IBX Insights.
