A Guide to Understanding Health Insurance

Shopping around for a health insurance plan? When trying to figure out how much you’ll owe for a service, like a medical scan, it’s hard to get all the information you need in one shot.

Buyers can quickly get caught up in a mess of terms, like “co-insurance”, that can be difficult to understand. But be careful – the fine print matters, and if you don’t understand what you’re agreeing to, you could be on the hook for thousands of dollars.

Here’s a quick primer:

Premium – the amount you’ll need to pay each month just to keep your plan active, even if you don’t have any medical expenses. If you don’t pay your premium, your coverage will be terminated, and you’ll be on the hook for all expenses occurring after your last covered month.

Deductible – the total medical expenses you need to pay out-of-pocket each year before your insurance shares any costs. The amount paid into your deductible usually resets at the start of each calendar year. Some plans cover office visits, prescription drugs, and/or preventive services (like vaccinations and screening tests) before you’ve paid your deductible.

Co-pay – a flat amount that you pay out-of-pocket for services after meeting your annual deductible. If the service is covered before your deductible is met, you may still be responsible for the co-pay.

Co-insurance – a percentage that you pay out-of-pocket for services after meeting your annual deductible. If the service is covered before your deductible is met, you may still be responsible for co-insurance.

Out-of-pocket limit – the most you have to pay out-of-pocket per year, including all expenses (deductible, co-pays, co-insurance). Of note, this does not include services that aren’t covered by your plan (such as cosmetic surgeries).

Prior authorization – advance permission from your insurer to obtain an expensive service, like a scan or procedure. Usually your doctor will need to prove medical necessity. If you obtain a service without prior authorization, you may have to pay the entire bill on your own. Services obtained in an E.R. or hospital generally don’t require prior authorization.

In-network and out-of-network – insurance companies contract with individual doctors, laboratories, imaging centers, and hospitals to provide services at agreed-upon rates. If you obtain services at out-of-network facilities, your plan may not help with the bills or even count the expenses against your deductible or out-of-pocket limit.

Phew! Got all that?!

Medmo is designed for people who don’t have health insurance or have a high annual deductible. If you need a scan, you don’t want to risk a bill for thousands of dollars. With Medmo, you set your price, and we find a center that can accept it.

To book a scan, visit us at Medmo.com. Medmo helps people schedule radiology imaging tests – such as MRI, CT scans, PET, and more – at nearby accredited centers and identify the payment solution that works best for them.