Health Insurance Pop Quiz

How much is your deductible?

How about, your out-of-pocket limit?  Does your health insurance have one?  If so, which costs that you pay out-of-pocket do NOT count toward your out-of-pocket limit?

Which health care services are excluded from your plan?

Confused by your health insurance benefits?   Join the club.  Many of us get lost in the jargon and legalese when we try to understand our coverage and make effective comparisons between plans when shopping.  That’s unfortunate, because health insurance is one of the most important and expensive things we buy.  But shopping for and understanding insurance is about to get easier.

Starting this week, the Affordable Care Act requires insurance companies to supply new comparison “labels” called the Summary of Benefits and Coverage.

This summary provides key information on an insurance policy – deductibles, out-of pocket limits, coverage for essential benefits, the difference in costs to you if you see an out-of-network provider, excluded services, and a glossary of terms.

The summary will also contain examples of what the plan would cover and what you’d have to pay in some common medical scenarios—having a baby and managing Type 2 diabetes, for example.

The information in the summary will be organized the same way for each plan, so you can make effective comparisons when deciding between coverage.

The new Summary of Coverage and Benefits will provide real help to consumers navigating the complex health insurance system, so it’s no surprise that a Kaiser Family Foundation poll found that the new easy-to-understand plan summaries are the most popular provision in the health reform law.

As we approach annual open enrollment for many employer plans, the summaries will help employees make informed choices between plans, if their employer offers multiple options, and they’ll help parents who each have job-based insurance decide which plan to add their children to. Even if you don’t have multiple plans to choose among, the summary will help you understand your benefits better.

These summaries are available now, so make sure to ask your employer or insurer for it.

Written by: Stacey Pogue, Center for Public Policy Priorities

Posted in The Texas Treatment|

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