A healthy living blog from Marshfield Clinic Health System

Navigate health insurance: Understand key terms and plan benefits

No one knows you better than you do, so be your own best advocate when making decisions about your health insurance.

Illustration – Understanding basic insurance lingo, health insurance costs

Choosing a health plan

Choose a health plan that includes your preferred providers and pharmacy services.

Know if the plan you’re considering lists your doctor as “in-network” to decrease your out-of-pocket costs. This includes evaluating specialty, urgent and hospital care. Health problems can arise after hours and on weekends or may require seeing a specialist. When possible, using providers or facilities in-network can save you money.

Some prescribed medications may have lower-cost versions available. Choose a plan that includes ongoing medications for you or your family at the lowest possible cost and with convenient pharmacy services.

“The ‘No Surprises Act’ requires health plans and providers to work together to offer estimates prior to services. You can find estimator tools with your health plan or where you are receiving services,” said Becca Normington, marketing and communications director for Security Health Plan.

Understand common health insurance terms

Deductibles, copays, co-insurance and non-covered services are all out-of-pocket costs. When you’re reviewing health insurance costs, these are key costs to compare as you’re considering which to choose.

Here are the common insurance terms definitions:

  • Deductible: A fixed amount that a patient must pay each year before their health insurance benefits begin to cover the costs.
  • Co-pay: A set amount that  you pay for a covered product or service, while your insurance pays the remaining cost. This usually does not count towards your deductible.
  • Co-insurance: The percentage of costs you pay after you have met your deductible.
  • Out-of-Pocket costs: Expenses you pay for. These include deductibles, co-pays, co-insurances and costs for services that are not covered by your plan.

You don’t have to be an expert about health insurance costs because there are resources you can utilize for questions. If you already have a plan, you can connect directly with your health insurance provider to speak with a care coordinator to discuss your questions and provide information.

Your care team is a great resource to help understand your care. If you’re a Marshfield Clinic patient, you can communicate with your doctor by sending a secure message within your My Marshfield Clinic account.

Simply opting out of having health insurance is not an option. You will be required to pay a fee if you can afford insurance but choose not to buy it. Most people under age 65 are required to get a plan through their employer, through Medicaid or through the Health Insurance Marketplace.

RELATED RESOURCE: Download this checklist about information needed to enroll in the Marketplace.

Preventive care and using included benefits saves money long-term

Take care of yourself and get the most from your health plan by staying active, choosing healthy foods and scheduling appropriate health screenings and vaccinations. Make the most of appointments by preparing questions for your provider. Use free preventive benefits from your health plan to help you stay healthy.

For health insurance and billing questions, talk to our patient assistance center.

Learn more about the Patient Assistance Center

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