Utah health insurance

Balancing monthly premiums with out-of-pocket costs

As with all Utah health plans, you’ll have to pay a monthly premium each month. But it’s also important to know how much you have to pay out-of-pocket for services when you get care.

Plans in the health care marketplace are separated into 4 different categories: Bronze, Silver, Gold, and Platinum

Premiums are usually higher for plans that pay more of your out-of-pocket medical costs when you get care. For example, if you have a Gold plan 80%, you’ll likely pay a much higher premium, but may have lower costs when you go to the doctor or use another medical service. So ask yourself how much you go to the doctor, will you need future surgery. Do you have on going health issues?
With the Bronze plan 60%, you’ll likely pay a much lower premium, but you’ll pay a higher share of costs when you get care.
Platinum plans 90% will likely have the highest monthly premiums and lowest out-of-pocket costs. The plan will pay more of the costs if you need a lot of medical care. These plans will most likely only be offered off the exchange meaning most companies will not be offering these plans on the marketplace.
Remember the lower the premium, the higher the out-of-pocket costs when you need care; the higher the premium cost, the lower the out-of-pocket costs when you need care
If you happen to qualify for out-of-pocket savings, you must choose the Silver plan to get the savings. If you qualify for these savings, you’ll get the out-of-pocket savings benefits of a either the Gold or Platinum plan for the Silver plans price. It is quite amazing the plan you can get for the price if you qualify for the silver plans out of pocket savings. But remember, you can choose any category of plan, but you’ll get the out-of-pocket savings only if you enroll in a Silver plan.
Overall just think about the health care needs of your household when considering which Marketplace insurance plan to buy in Utah. Also you will want to think about which company and what doctors are on that list. Certain companies on the exchange will only cover a certain area. And with most of them they will all be HMO Plans. Call our office at 801-900-5636 or see our free informational site at Utahhealth.com to find out which plans and doctors are covered on the exchange and off the exchange. Get started now and review over 150 health plans in Utah.

1. What is a Copay

A Co-pay is your portion of the bill after the deductible has been meet. In most cases you will have a $25 co-pay to see your primary doctor and if it is a specialist it maybe higher such as 40 or even 50.

2.What is Coinsurance

Most people are familiar and know what a co-pay is, but what about coinsurance?

Coinsurance is similar as to co-pay. Basically It’s your portion of a medical bill after your main deductible has been meet.

The difference between the two is that coinsurance is a percentage such as 90/10 or 80/20 while a co-pay is a fixed amount such as $25

What do these number mean? It’s very simple these numbers mean you pay for 10 percent or 20 percent of the bill after your deductible has been meet

After that your insurance company will pick up the tab for the rest of the approved amount up to the OOP or out of pocket maximum

3. What does Maximum out-of-pocket or OOP mean?

The Maximum out-of-pocket annual spending means that once you have paid a certain amount for the year, your insurance company will begin paying 100 percent for all covered services.

One important thing to look out for when looking at the OOP or out of pocket maximum is that if your making a claim on an “out-of-network” you will most likely be paying a complete separate OOP and deductible

so be careful to stay inside your network so you’re not paying 2 deductibles. This could get very expensive.

What to know how much health insurance costs in Utah? enter your zipcode below to find out.

UtahHealth.com