You know you need it. Whether it’s getting an individual plan or renewing with your company, health insurance is in your future. And with the Affordable Care Act (ACA / Obamacare) fees tripling in 2015* and the price of doctor visits continuing to rise, it’s in your best interest to know the plan that is right for you and your lifestyle.

How do you do that? Ideally, you will compare the possible plans together to find the best option. If you’re on the individual exchange, there are “compare tools” available for you to use. For those at a company that offers insurance, there is often a broker or support line you can call, if not online information, that can help with questions you may have.

However, before you start reviewing this information, here are a few key terms to help better prepare you for your health insurance journey. The more you know in advance, the better off you will be selecting the best option, as well as constructing the right questions to ask your support team.

What is a premium? For individual insurance coverage, you might pay your premium annually or in smaller payments over the course of the year. If you have insurance through your job, premium payments are managed through your employer.

What is an out-of-pocket expense? Your health insurance plan doesn’t pay for every medical expense you’ll have during the year. Because health insurance is a way to manage the financial risks of illness and injury, many health care expenses fall outside of what’s covered by your insurance. These expenses that you pay for outside of your premium are out-of-pocket expenses. Here are some examples of out-of-pocket expenses:

• Pre-deductible expenses: At the start of the year, most of your health care spending is not paid—until you’ve reached your annual deductible. Your out-of-pocket expenses on covered services counts toward your deductible.
• Coinsurance: Once your spending has reached your annual deductible, a percentage of your covered health care expenses are covered by your health insurance plan. This is called coinsurance. For example, if your plan covers 80%, then you are responsible for 20% of expenses. Your percentage is an out-of-pocket expense.
• Non-covered services: Some health care expenses—like chiropractic, vision and alternative care—may not be covered by your health insurance plan. In those cases, you’re fully responsible for paying out-of-pocket for those services.

What is a deductible? Your health plan’s annual deductible is the amount you must pay each year for covered medical expenses before your health insurance starts paying its share of subsequent expenses.

Because health insurance is a way to manage the financial risks of illness and injury, deductibles are one of the ways for you to choose how much of that risk you’re willing to manage.

To learn more information on health insurance, visit the Regence reference page here. Are you part of a small company in the tech industry that doesn’t have health insurance? Why not learn more about the WTIA health trust and how it can help you! https://washingtontechnology.org/health-trust/

---

By Kendal Sasso, Field Marketing Analyst, Regence BlueShield, Kendal.sasso@regence.com

* Information taken from healthcare.gov:

“If you don’t have coverage in 2015, you’ll pay the higher of these two amounts:

2% of your yearly household income. (Only the amount of income above the tax filing threshold, about $10,000 for an individual, is used to calculate the penalty.) The maximum penalty is the national average premium for a bronze plan.

$325 per person for the year ($162.50 per child under 18). The maximum penalty per family using this method is $975.”

The cost in 2014 was $95 per person.

Direct source: https://www.healthcare.gov/fees-exemptions/fee-for-not-being-covered/