Tatva-Artha

If you are shopping for insurance for yourself, you are not alone with all the options that are available out there and the complex web of things that you need to consider. But … I’ve been trying. Here is a list of things that I’ve come up with that one should consider when shopping for insurance.

Copay: This is the upfront cost that we have to pay when visiting doctor for routine physical, illness, immunization, child wellness and other services. In-network, amount is normally $10-20. Out-of-network is usually higher.

Co-insurance: The percentage of expense that insurance company pays for non-routine expenses. In-network, these are normally 80-20, or 90-10. 80-20 means insurance pays 80% and we have to pay 20%.

Deductible: This is a fixed amount that we have to pay every year before co-insurance kicks in. This is normally anywhere from $250 to $2000. Higher premiums cost less premium on coverage.

Out-of-pocket-maximum: This item protects a patient incase if there is a major medical expense that occurs. This is the maximum medical expense that we have to pay (per year) after which the insurance company pays full 100% of expense (regardless of what co-insurance percentage is). This is usually anywhere from $1000 to $5000.

Prescription Drug Coverage: I have seen 3 levels of drug coveage: “Generic” drugs usually cost $10, “Brand Name/Formulary” cost $20 and “Non-preferred Brand Name/Formulary” cost $35. I believe, this are prices for monthly supply of drugs and I am not sure how to find which of your existing drugs fall under which category.

Pre-existing condition & Waiting Period: This is a very important thing to conside when changing or renewing your insurance. Any brand new insurance that we buy usually doesn’t not cover any existing illnesses (called pre-existing condition) for a certain period of time (called waiting period). Existing illnesses are any medical condition for whic we have taken treatment or even advise from doctor. Insurance companies are known to reject illnesses that patients have just discussed with doctor. When buying temporary insurances and renewing them, make sure insurance companies are not issuing brand new coverage. Such “new” coverages don’t cover pre-existing conditions.

Each of these topics are a blog post in them-selves. Plus these are just the beginning. There are a lot more other things that we may need to ask for including hospital services charges, mental health issues, therapies etc. Plus this is just medical insurance and does not cover dental/vision. These are just a few basic things which can help us weed out the crap of  insurance companies and options and focus on rest.

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