Determine Plan Affordability

Affordable options are often a main concern when comparing health insurance plans. The monthly premium, as well as the payment required when medical services are rendered, are considered when budgeting for a plan. A higher out-of-pocket cost at the time of service generally translates to a lower monthly premium.

High-quality health care leads to happiness and well-being. A health insurance policy, the contract between an insurance company and a policy holder, is intended to safeguard against high and unexpected health care costs. Although policy holders pay a monthly premium, co-payments, co-insurance, and deductibles, it is expected that the total is far less than what may be required if paid fully out-of-pocket.

Affordable options are often a main concern when comparing health insurance plans. The monthly premium, as well as the payment required when medical services are rendered, are considered when budgeting for a plan. A higher out-of-pocket cost at the time of service generally translates to a lower monthly premium.

Several factors may affect plan affordability:

• Plan – projected future health care needs
• Co-insurance – a specified percentage of the cost of medical services that is paid by the insured after a deductible is met
• Co-payment – a preset fee paid by the insured each time medical care is accessed or medications are purchased
• Deductible – a specified amount paid by the insured before the insurance company compensates for medical care
• Exclusions – predetermined services that an insurance company does not pay for
• Life-time payout – a specified maximum amount an insurance company will pay during the lifetime of the insured
• Non-covered specialty services – services provided by medical specialists that are limited or not covered at all
• Out-of–plan services – necessary specialty services not available from in-plan providers
• Out-of-pocket maximum – a specified annual limit that is paid by the insured before benefits are paid at 100% by the insurance company
• Riders – amendments permanently excluding services to a specific condition