Just under half of Americans with health insurance feel confident that they understand basic insurance terms, according to a study in the Journal of Health Economics. If you’re one of those people who don’t completely understand the ins and outs of your health insurance, this guide can help.
Why we need health insurance
- Accidents or health problems can happen at any time.
- Health care expenses are the number one cause of bankruptcy in the U.S.
- Health insurance provides access to a network of doctors and hospitals that have negotiated lower rates with the insurance companies.
CarePoint Health is now in-network with Horizon Blue Cross Blue Shield of New Jersey
If you have Horizon Blue Cross Blue Shield insurance, you’re now covered as in-network at our hospitals (Bayonne Medical Center, Christ Hospital in Jersey City and Hoboken University Medical Center), and as Tier 1 with CarePoint Health Medical Group doctors. That means you’ll have lower out-of-pocket costs to award-winning health care in Bayonne, Hoboken and Jersey City.
In addition, CarePoint Health does not restrict access to care based on your insurance benefits. A list of additional in-network insurance carriers with Bayonne Medical Center, Christ Hospital in Jersey City, Hoboken University Medical Center and CarePoint Health Medical Group doctors can be found here.
5 things you should know about your insurance:
- You pay for insurance two ways
- Premium: the amount you pay to the health insurance company each month (or quarter) to maintain your coverage.
- Out-of-pocket expenses: can be some combination of deductibles, copays or coinsurance.
- Your deductible is the amount of money you must pay each year to cover eligible medical expenses before your insurance policy starts paying.
- A copayment, also known as copay, is a specific flat dollar amount you may need to pay a provider, usually for each service or treatment, such as $25 for a checkup.
- Coinsurance is a percentage of costs that you must pay after your deductible is met. For example, you may have a deductible of $250 before insurance will cover 80 percent of charges, leaving you responsible for the other 20 percent—known as coinsurance.
- Difference between high and low premiums
In general, if you pay a higher premium upfront, you will pay less when you receive medical care. If you pay a lower premium upfront, you will pay more when you receive care.
- If you already know you have an expensive medical condition, consider a plan with a higher premium that covers more of your costs.
- If you are generally healthy you might come out ahead paying a lower premium and a bigger share of your health costs, because those costs are most likely not going to be that high. Of course, you need to be prepared to pay more if you do unexpectedly become sick or injured.
- There are out-of-pocket limits
This is the total of your deductible, copays, and coinsurance (but does not include your premiums). Once you hit this limit, the insurance company will pick up 100 percent of your costs for the remainder of the year.
- Which benefits are covered
The Affordable Care Act requires most health insurance plans to cover outpatient surgery, emergency services, hospitalization, maternity and newborn care, mental health and substance abuse services (including behavioral treatment and prescription drugs), rehabilitative services and devices, laboratory services, preventive and wellness services, chronic disease management, and pediatric services that include oral and vision care. Each state, however, has significant latitude in establishing these benefits.
- What it means to be "in-network"
In-network is a health care professional, hospital or pharmacy that is part of a health plan’s network of preferred providers. You will generally pay less for services received from in-network providers because they have negotiated a discount for their services.
You should also know, New Jersey law mandates that New Jersey insurance companies always cover emergency room services as in-network,* including hospital stays. That means you are only responsible for your deductible or out-of-pocket expenses, no matter where you receive care.
This is to protect patients in a medical emergency to ensure they receive access to the closest, most appropriate care in the event of a medical emergency, regardless of network status.
How we can help
Now that you know a little bit more about how health insurance works, you may still have questions. CarePoint Health’s concierge service offers you help—at no charge—with your insurance questions, as well as things like choosing the right doctor, quicker appointments, faster access to your medical information, referrals and pre-authorizations to assure you’re covered, and more. Simply call us at 201.884.5329 to get started.
*Not all plans issued in the state of NJ are governed by NJ law. Certain employer sponsored plans may fall under Federal ERISA law. Coverage for emergency services for these plans should be clearly defined in your summary of benefits. If you have any questions regarding your coverage, we encourage you to contact your insurance carrier.