Ohio Health Insurance Guide

5 Minute Guide to Selecting a Health Insurance Plan

Ohio Medical Insurance 5 Minute Guide

Ohio health insurance terminology can really get confusing. You need to learn to "talk the talk" so to speak. Otherwise, you will not be able to understand an offer when it is made to you. You should never buy health insurance unless you understand what you are buying.

This guide will take you about 5 minutes to read and will give all the knowledge you need to understand your health insurance.

Contact Us at 800-272-0512 Monday - Friday, 9 AM to 8 PM

Basic Terms

I am going to give you the basic terms that insurance agents use and illustrate each one with a simple example. I promise you that this will not be difficult.

Deductible - A deductible is what you pay out for medical expenses before the insurance company steps in and starts to help. A deductible for health insurance is no different than a deductible for auto insurance or home insurance.

You will generally find that the higher the deductible, the lower the premium. Your job, or an honest health insurance agent's job is to find you the perfect balance between deductible and premiums.

Not all plans pay everything after you meet your deductible. Some have coinsurance. I will give you and example using both of these terms in a moment.

Coinsurance - Once you reach your deductible, the insurance may pay for everything after that. If they do, you have a 100% plan. But most times you will see someting that refers to an 80/20 split. This split speciifies that after you pay your deductible, the insurance company will pay part of the expenses (80% in this case) and you will pay part of the expenses (20%) until you have reached your Maximum Out of Pocket.

This can be tough so I am going to give you an example now.

John is admitted to the hospital for a gall bladder operation. He has a health insurance plan with a $3,000 deductible and coinsurance of 80/20. His maximum out of pocket expenses as stated in his policy is $5,000.

John has his surgery and is released from the hospital. His entire bill, after the insurance company adjusted it for using an in network hospital, was $35,000.

Since he has a $3,000 deductible, John is responsible for the first $3,000 of the bill. That would then leave $32,000.

The plan will now cover 80% of the bill and John will pay 20%. But, 20% of the remaining $32,000 is $6,400 and we already told you that his Maximum Out of Pocket (in network) is $5,000. Therefore, John will pay 20% of the bill but no more than the $5,000.

How much did he pay total? Well, first he paid his $3,000 deductible and then he paid his 20% coinsurance until he hit is $5,000 limit. So, he paid $8,000 for his hospital stay.

Some plans have lower deductibles and maximum out of pockets and some are higher. Also, there are 100% plans where once you meet your deductible, everything is covered 100%

Do I have to meet a deductible before the plan covers a doctor visit or a prescription?

No, generally you do not. But let us move on to discuss doctor copays

Copay - A copay is what you pay for a physician office visit or prescription. You do not have to meet a deductible for office visits. However, many (most) plans do have a special deductible for brand name, non-generic prescriptions.

I just want to make sure this is clear. Once your plan starts up, you can go to the doctor and just pay the office viist copay. You do not have to first meet a deductible.

PPO or HMO?

We do not sell any HMO plans in Ohio. All the plans we offer are PPO. This means Preferred Provider Organization. It allows you to see any network provider you want at any time. You do not need to get a referral.

High or Low Deductible?

Very low deductibles are sucker bait. Unless someone is paying for your health insurance or you are 20 years old and in perfect health, you will pay a disproportionate amount for your health insurance. What you need to look at is the premium amount difference between deductibles.

For example, if a $1,000 deductible is $300 a month and a $2,500 deductible is $220 a month, which is the better value? Well, do you think it is worthwhile to spend $960 a year to lower your deductible by $1,500? After you have been on the plan for a year and a half you will have paid the carrier the $1,500 difference. From then on you will be paying too much. Unless you buy a plan and go to the hospital within a month or two, there is no point in having the $1,000 deductible.

Other things you might want to know

All health insurance plans have unlimited coverage. There are no longer caps on the amount they will pay out.

All health insurance plans will cover a physical without meeting a deductible.

Even though an adult can be denied health insurance due to medical condition, a child on a plan with an adult cannot be denied coverage.

Is that it?

Yes, that is about all you need to know about health insurance to talk to an agent and be an intelligent consumer.

If you call me I will enroll you. It takes me about 5 minutes.

Contact Us at 800-272-0512 Monday - Friday, 9 AM to 8 PM