Having a health plan is important. We all know how expensive a hospital visit can be. A typical emergency room visit can cost as much as $20,000. Astonishing, isn’t it? With so many plans on the market, it can be hard to determine which health plan to choose. The key is to look for a plan that fits your life and your budget. One of the most important things to consider is the health plan benefits that are offered.

Each plan offers a different set of benefits. Why pay for a plan that offers maternity coverage if you’re a male who definitely doesn’t need this type of coverage? Some areas to consider when looking at a plan are: co-pays, deductibles, out of pocket expenses, and percentage of coverage. The policy’s percentage of coverage is what the health insurer will pay after you have paid your portion (co-pay, deductible). Most plans are what we like to call the 80/20 plans. This means that after you pay your portion (co-pay, deductible), the plan will cover 80% of the remaining fees and you will be responsible for 20% of that remaining balance. A co-pay is a fee you pay for a service above the percentage you are responsible for. So you may have a $20 co-pay for each office visit at the doctor’s office. The deductible is the annual amount you must pay “before” the health insurer will even begin to pay their portion. So if you have had a $500 deductible, then the health insurer will not pay anything until you have paid the first $500.

So let’s put this together so it is easy to understand when it comes to the health plan benefits. Let’s use the information above and say you need to go the doctor. You’d have a $20 co-pay that you would pay at the office visit. The doctor runs some tests, does some routine checks, etc. You leave and the doctor bills your insurance company. You have a $500 deductible and the total bill is $850. So the first $500 is your responsibility. That leaves a balance of $350. Of that $350, the insurance company will cover 80% of that and you will be responsible for the remaining 20%. Now you’ve met your deductible for the year, future visits will only be subjected to your co-pay and the balance is then split 80/20 between the health insurer and you.

This is just an example, and while each plan is different, this should provide you with a brief overview as to what you need to look for when reviewing your health insurance plan’s benefits and coverage. The key is to find a plan that fits your life.