Imagine
you have a one hundred thousand dollar heart surgery which is the covered
medical expenses under your health insurance plan and let's say this health
insurance plan has a one thousand dollar annual deductible 20 percent
coinsurance after deductible a two thousand dollar out-of-pocket limit and a
two million dollar annual limit on your health insurance coverage in this
article we will explain how these different components of a health insurance
policy work before we begin it's important to note that any health insurance
policy purchased after September 23rd 2010 will not have a lifetime maximum
limit on most to the plan benefits and any health insurance policy purchased
after january first 2014 will not have an annual limit on most platinum the
first thing we'll talk about in this video is a deductible what is a deductible
typically a deductible is the amount of money you must pay
each
year before your health insurance plan starts to pay for covered medical expenses
so with a one hundred thousand dollar heart surgery bill you are responsible
for paying the first one thousand dollars after this one thousand dollar
deductibles met the insurance company will pay percentage up the bill and you
will pay the car insurance let's talk about coinsurance what is car insurance
typically coinsurance is a cost-sharing requirements where you are responsible
for paying a certain percentage and the insurance company will pay the
remaining percentage up the covered medical expenses after your deductibles met
for health insurance plan 20 percent coinsurance one-third deductibles met
the
insurance company will pay eighty percent of the covered expenses Mon you pay
the remaining 20 percent until your out-of-pocket limit reached for the year
what is in at a pocket limit typically the out-of-pocket limit is a maximum
amount you will pay out of your own pocket for covered
medical
expenses in a given year for a plan with a two thousand dollar out-of-pocket
limit
you
will pay a one thousand dollar deductible and one thousand dollar coinsurance
while the insurance company covers the remaining ninety thousand dollars a
heart surgery bill even if you're hospitalized again in the same here the
insurance company will pay 100 percent be covered expenses
until
you reach your annual coverage limits what is an annual coverage limits some
health insurance plans place dollar limits upon the claims and insurance company
will pay over the course of a plan here so if you bought an insurance policy
with an effective date of July 2011 your plan year was run from July 2011 until
June 2012 if you have an annual coverage limits two million dollars and you
have medical bills that cost more than two million dollars
during
your plan year you would be responsible for paying those bills at aviano pocket
once your new plan your begins in July 2012 your deductible coinsurance
out-of-pocket limit an annual coverage limits would all reset an insurance
company would once again begin to pay your cover claims beginning September
23rd 2010 the Patient Protection and Affordable Care Act health care reform
begins
to phase out annual dollar limits starting on September 23rd 2012 annual limits
on health insurance plans must be at least a two million dollars by 2014 no new
health insurance plan will be permitted to have an annual dollar limits on most
covered benefits some health insurance plans purchased before March 23rd 2010 have
what is called grandfather status health insurance plans with
grandfathered
status are exempt from several changes required by health care reform including
this phase out annual limit on health coverage here's one more concept you
should be familiar with some health insurance plans offer co-payments what is
the copayment typically a copayment for copay
is
a specific flat fee you pay for each medical service such as thirty dollars for
an office visit after the thirty dollar copy the insurance company pays
remainder the covered medical charges sometime subject to the deductible and
coinsurance certain recommended preventive services immunizations
and
screens are covered with no cost-sharing copayment on health insurance plans
purchased after March 23rd 2010 let's say you're not feeling well and went to
see your doctor who charges two
hundred
dollars for the office visit if your insurance plan has an office visit
copayment up thirty dollars the new only be responsible for the thirty dollars
and the insurance company will cover the remaining one hundred and seventy
dollars but if you purchased your health insurance policy
after
March 23rd 2010 and you're due for routine preventive care screening like a mammogram
or a colonoscopy you may be able to receive that screen without making a
copayment you can talk to your insurer or your license key health insurance
agent if you need help determining whether or not you qualify for screening
without a copay there are five important changes that occurred with individual
and family
health
insurance policies
on
September 23rd 2010 those changes are added protection from rate increases
insurance companies will need to publicly disclose any rate increases and
provide justification before raising your
monthly
payments added protection from having insurance canceled an insurance company
cannot cancel your policy except in cases of intentional misrepresentations or
fraud coverage for preventive care certain recommended preventive services
immunizations and screens will be covered with no cost-sharing requirements no
lifetime maximums on health coverage no lifetime limits on the dollar value
those health benefits deemed to be essential by the Department of Health and
Human Services
no
pre-existing condition exclusions for children if you have children under the age
of 19 with pre-existing medical conditions their application for health
insurance cannot be defined due to pre-existing medical condition in some
states a child may need to wait for the state open enrollment period before the
application can be approved.
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