Starting the process of choosing a health care plan can be daunting, especially for people who aren't familiar with the lingo involved in the health care system.
While you're scoping out your health plan, here are a few key terms to pay attention to:
The first cost you'll encounter is your premium, the set amount of money that you'll pay the insurance company for your health plan. Most people pay these each month.
Benefits are what you get under that health insurance plan, like hospital stays, cancer screenings, or prescription coverage. Your plan should tell you which services are covered and which aren't. All plans offered through Vermont Health Connect offer the same basic benefits.
A co-pay is the flat amount you will have to pay when you receive a covered medical service. The cost of that co-pay depends on the service and your plan. It does not count toward your deductible, which is what you have to pay before your insurance starts helping out.
The allowed amount is the maximum that the insurance company will pay for a service.
Co-insurance is the percentage that you'd pay for a medical service. So your insurance might cover 80 percent of a hospitalization, leaving you responsible for the other 20 percent. The exact amounts depend on the plan you choose.
Co-pays, co-insurance, and money you pay towards your deductible are two examples of out-of-pocket costs you will encounter. The federal health care law sets limits on those costs that you or your family will have to pay.
These are only a few of the basic terms, and if you run into other unfamiliar terms during your search, the Vermont Health Connect website has a glossary where you can quickly look them up. A link to that is here: http://healthconnect.vermont.gov/about_us/glossary
And there are other resources available for those with questions.
((SOT Mark Larson, Vt. Health Access Commissioner 185157 "Starting in October there will be a website that will provide easy access to side-by-side comparisons where people can go on, compare plans, pick the plan that's best for them, secure fiancial support for paying for their premiums if they qualify, and then be able to get coverage for January 1," says Vermont Health Access Commissioner Mark Larson.
Businesses or people with insurance questions can also contact Vermont Health Connect's hotline at 1-855-899-9600. Or visit their website, http://healthconnect.vermont.gov/. There you can find resources, including how to find a navigator in your area who can help guide you through the transition. Navigators can help you compare what you have now to available options, understand the terminology, and help you figure out your priorities for your health care.
"People have time through the fall to be able to purchase a plan for January. So people don't have to rush out on October 1 to make there decision," Larson says. "Again, there's plenty of time to look at the information on the website, to call the call center if you have questions, or to sit down with somebody in your community as a navigator in order to work through what your options are."
Finally, another thing everyone should know is that when you purchase a plan, it will be a year before you can change it, except for significant life events like the birth of a child.
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