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Tips for Health Insurance Open Enrollment

The new year is fast approaching and while that means holiday parties and family events, it also means Open Enrollment for health insurance is almost coming to a close. The last day to get health insurance coverage for 2019 is December 15, 2018. You can browse plans and apply at healthcare.gov. With all the plans available, it can be confusing to know which one is the right one for you. For starters, it can be helpful to understand some of the terminology.

Deductible – An amount you will have to pay out-of-pocket before your insurance coverage kicks in. If you plan on using health services often in the upcoming year, it will be beneficial to have a low deductible plan. You will pay a higher monthly cost, but it can save you money if you use health services somewhat frequently. Upcoming surgery, chronic health issues or having hobbies associated with injury (i.e. Crossfit, skateboarding) are just a few reasons why it can be beneficial to have a low-deductible plan.

Co-pay vs. Co-insurance – Co-pays/Co-insurance are what you pay on a visit to a health care provider after your deductible has been met. The amount varies depending on the type of service you go to (i.e. visiting a cardiologist will likely have a higher co-pay than visiting your primary care doctor). The difference between a co-pay and co-insurance is that a co-pay is a fixed dollar amount and co-insurance is a percentage based on the services rendered. For example, if the total cost your insurance pays for a service is $100 and you have a 20% co-insurance rate then you will pay $20 and your insurance will pay the remaining $80.

In-network vs. Out-of-network – These terms refer to whether or not a health care provider is credentialed with a certain insurance company or not. If the provider is in-network with an insurance, that insurance will cover services rendered by that provider. If the provider is out-of-network with an insurance, that insurance may cover a smaller portion of the services or not cover the services at all. If you go to a provider that is out-of-network it will be more expensive for you than one that is in-network.

Capitol Physical Therapy accepts most major commercial insurances. We will take care of verifying your benefits and bill your insurance directly. Have a happy and healthy new year!