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Health insurance is an essential coverage that helps to protect you and your family financially by helping you pay for medical and health
care expenses. My name is Dr. Andrew Schneider and I'm a podiatrist in Houston, TX. Health insurance can include coverage for preventative care
such as annual physicals, vaccines and checkups, treatments for existing illnesses or injuries, hospitalization and emergency care if needed. It also covers prescription drugs.
Generally, health insurance is a contract between you and an insurance company that you will pay premiums in exchange for coverage of your medical costs. You typically pay a monthly or yearly premium to the health insurance company, which then agrees to cover your risk of monetary losses in case of a covered accident, injury or illness.
Let's talk about the important pieces of Health Insurance. First is the insurance premium. A health insurance premium is the amount of money that you pay to your health insurance company on a regular basis in exchange for coverage. This payment is usually made monthly or annually and can vary depending on the type of plan you've chosen. The premium helps to cover the cost of medical care, treatments, hospitalization, and other services covered by your health insurance policy. It's important to note that just because you pay your premium, it does not mean you're covered a 100% percent for healthcare. There are other payments that will be required as you seek care for your healthcare needs.
A health insurance deductible is the amount of money that you must pay out of pocket before your health insurance company will start to cover the cost of your medical care. This means if you have a $1,000 deductible, you must pay the first $1,000 in medical costs before your health insurance company will start to cover the remaining costs. The purpose of having a deductible is to help keep premiums lower by having individuals pay for some of their own healthcare expenses. Paying a deductible can also help encourage people to be more mindful about their healthcare decisions and make sure they're getting the necessary treatments and services.
In some cases, the deductible is only applied to tests and procedures. If you go in for an office visit, you'll need to pay your copay, but the rest of the visit would be covered. In other cases, the deductible applies to office visits too and you'll be responsible for paying everything until you reach your deductible. This is determined by the insurance plan you choose.
A health insurance copay is a fixed amount of money that you must pay for each doctor's visit. The payment is usually due at the time of service and is in addition to any deductible or premium payments that you have already made. Copays used to be $10, but now we're seeing copays as high as $75 or more. Generally speaking, the higher the copay amount, the lower the premium.
In most plans, once you hit your deductible, there's more comprehensive
coverage from the health insurance company. In most cases. However, you're still going to pay 10 to 20% of the total amount. This is usually in the form of a co-payment or co-insurance. Co-payments still need to be paid at every visit, even after you met your deductible. In most cases, individuals will still need to pay 10 to 20% of their costs even after you met your deductible. This is called co-insurance.
Do the payments ever end? Yes, that happens when you meet your maximum out of pocket. The health insurance maximum out of pocket is the total amount of money that you're responsible for paying for your healthcare costs in a given year. Once you reach this limit, your health insurance company will cover all remaining costs for the remainder of the year. This means you will not have to pay any additional copays or coinsurance payments and will be able to receive care without the additional financial burden. This limit can vary depending on the type of plan you've chosen, but is typically sent in an amount that it's affordable for most people.
So let's talk strategy. If you know you're going to need an elective or routine procedure such as a colonoscopy, try to schedule it at the beginning of the year. This will make sure you've met your deductible and are close to reaching your maximum out of pocket. This way you can take advantage of the comprehensive coverage from your health insurance company once you hit your deductible. This will allow you to have the majority of the year with full coverage.
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00:00 Introduction
01:16 Types of Health Insurance
02:30 Health Insurance Premium
03:10 What is a deductible?
04:09 Health Insurance Copay
04:35 All about Coinsurance
05:05 Hitting your Maximum out of Pocket
05:44 Strategizing your health insurance year
06:55 How to connect with Houston podiatrist Dr. Andrew Schneider
