Most people only tend to think about the benefits of health insurance when they need it, whether it’s after a serious accident or illness. Both scenarios can lead to expensive medical treatments, so choosing the right plan is crucial.
While prevention is the best cure, life has a tendency to throw us curveballs. It’s important to understand how the right health insurance plan can help with life’s unexpected turns – and the best time to learn about the benefits of insurance is while you’re healthy.
The key benefits of health insurance
Like car and home insurance, health insurance can lower your medical costs for you and your family when something happens. Some benefits from having coverage can include:
- Preventive care to avoid serious or long-term illnesses
- Treatment for current health conditions
- Care management for new health problems or injuries
- Local network providers
- Lower costs for preventive and necessary care
Understanding health insurance plans
Even if you know about these benefits, understanding health insurance plans can be confusing.
You’ll want to choose a plan that provides the specific benefits you need. Some people have chronic illnesses and will want small copays for office visits and prescription drugs. Others face challenges starting a family and require particular services to aid with pregnancy. And most of us will find comfort and help with behavioral health services like talk therapy, but not all plans come with this.
Blue Cross and Blue Shield of North Carolina (Blue Cross NC) has several resources explaining the toughest insurance terms. Here are some of the key concepts you need to be familiar with to make the right choice for your needs.
Deductibles
A deductible is the amount you pay out-of-pocket for health care services covered by insurance before the plan starts to pay.
Once you’ve reached the deductible, you begin paying copayments. The insurance plan covers the remaining cost for each service. Plans with lower monthly premiums tend to have higher deductibles while plans with higher monthly premiums have lower deductibles.
Copayments
Commonly referred to as copays, copayments are amounts you pay for a health care service covered under the plan. Copays kick in once you’ve reached the plan’s deductible.
Copays are usually needed for office visits, lab tests, prescription drugs, and visits to specialists. Plans with lower monthly premiums tend to have higher copays while plans with higher monthly premiums have lower copays.
Network providers
There are 2 categories for providers: in-network and out-of-network.
A network consists of facilities, professionals, and suppliers that the plan has contracted to provide services. This is why costs are often lower when patients see in-network providers for services. If patients choose out-of-network providers, there is no contract in place to pay for much of the service cost.
Prescription drug coverage
Many prescription drugs are expensive. To lower those costs and make them available to patients who need them, health insurance plans help pay for these medications while members pay a copay.
This is one of the best benefits of health insurance for people with chronic conditions.
Mental health coverage
Like prescription drugs, many people need mental health treatment. Health insurance plans reduce the cost of mental health services, including therapy sessions and psychiatric care.
Patients typically only pay a copay for such treatments.
Choosing the right coverage for your needs
These are just a few of the benefits of health insurance you should be aware of each year when picking a plan during open enrollment or when you have a qualifying life event.
If you are thinking about switching plans, do your research to make sure your current – and future – health needs are covered, and that you and your family will be protected in case of emergency. The key is making the most of your plan’s coverage while staying within your budget.
Check out our Shop Plans page to explore plan options or to contact us for more information.