Shopping for a new health or dental insurance?
If you are one of the many self-employed or work for an employer that does not offer insurance benefits, you must take out health and dental insurance yourself or with the help of an insurance agent. This may seem overwhelming to some, but only a little research is needed to gain a better understanding of how insurance plans are organized.
When reading a health insurance policy, you come across insurance-specific conditions. These conditions tell you what you are responsible for and what the insurance company will pay.
Copay – This is a cost sharing agreement where the insured pays a fixed amount and the insurance company pays the rest. For example, you have a $ 50 fee for a doctor’s visit that costs $ 80. You pay the $ 50 and the insurance company pays $ 30.
Deductible – This is how much the insured person has to pay before the insurance company starts paying. The higher the deductible, the lower the monthly costs.
Coinsurance – This is another cost sharing agreement, but you pay a certain percentage and the insurance company pays another percentage. Example: Your office visit is $ 80 and you are responsible for 30%, which is $ 24. So the insurer pays 70%, in this case $ 56.
Waiting time – This is a way for insurance companies to cut costs and avoid paying for existing conditions. Waiting times vary, but there may be waiting times between 1 and 12 months for services that are covered later.
Dental insurance companies offer many plans, but most fall into the category of a savings plan, a network plan, or a fixed benefit plan. Each plan deals with preventive, basic and important services. Consumers need to be educated on what all of this means, since the three basic types of plans are very different.
The dental savings plan is cheap and only offers network discounts. Most offer discount ranges from 20% to 65%, depending on which provider you choose. Some people find these plans worthless and not very useful, but they are perfect for people who only need cleaning, few basic services, and no major services. The other thing to consider is that the network and the fixed benefit plan have a maximum number of benefits per year. This plan is not that it could supplement a network plan.
A network plan contains copays and deductibles. It offers more coverage with a focus on prevention services and is the most expensive option. This plan typically pays 100% of your prevention services and percentages of your major and major. Some have a waiting period for these services, others do not cover the main services at all. You need to determine if you are at risk of needing major services or if you can add a savings plan to the plan.
The fixed benefit plan pays predetermined money for covered benefits. If your family can’t afford a network plan, this is the next best option. This has no deductibles, but you have to pay the difference between the fixed benefit and the dentist’s bill. The best thing is that there are no networks so you can choose any dentist. You can also become a better consumer because you can ask the dentist about the prices to maximize your fixed benefits. This plan can also be supplemented with the dental savings plan because the money is sent to you and not to the dentist.
Understanding insurance-specific terms can be daunting when considering a contract longer than 30 pages. Consumers need to do their research, but I recommend speaking to a professional. I, a licensed insurance agent, have been trained and understand the special features of contracts. You are best prepared to explain the nuances that you may skip.