Health Insurance Policy | A detailed account of a health insurance policy.

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The Health Insurance Policy Continued

Prescription Drug Coverage

This is one of the most necessary, and probably one of the most misunderstood benefits in a health insurance policy. First of all, even if you’ve never taken a prescription drug in your entire life, you should still have some sort of prescription drug coverage in your health insurance policy. The reason is simple, you never know when you’re going to need prescription drug coverage until it happens, then you’re to late and paying for the medication out of your own pocket.

Health insurance companies handle prescription drug coverage in many different ways. They are well aware of how much prescription drugs cost, and they have actuaries working for them that know exactly the percentage of clients that will wind up using prescription drugs, and what that expense will cost them. Trust me, it’s in the billions, drug costs are soaring everyday. Bottom line, buy the coverage.

Most health insurance companies have some sort of prescription drug deductible in their plans. These deductibles can run from $250 to $1,000 and more. Many health insurance plans will allow you to buy down the deductible, for a price. Meaning, if your policy has a $1,000 deductible, many times you will have the option to reduce this to $500, or $250, for a few dollars. Also common now days is a zero deductible drug benefit for generic drugs

On the flip side, some health insurance companies will limit the amount of prescription coverage you can use in a year. Some will limit this to $1,000 a year, others it will be $2,500 a year. Know what you’re buying, a drug deductible, or a drug benefit limit, before you buy it.

It’s also a good idea to compare prescription drug co-pays when you’re comparing health insurance policies. The more prescription drugs you use, the more this will come into play. Co-pays for prescription drugs run from $4 to a percentage of the drug costs for certain speciality drugs. $25 to $75 co-pays are very common. If you use prescription drugs on a regular basis, you already know how important comparing drug co-pays can be.

One last thing about prescription drugs before we move on. Make sure you understand if your health insurance prescription drug coverage covers life style drugs, Viagra, Cialis, etc.. And if you use birth control, be aware some health insurance companies will cover this, some won’t.

Hospitalization and Intensive Care. Many health insurance policies will have a separate deductible for these services. This deductible can be $500 to $1000 or more. Also many times, this is above and beyond your regular annual deductible. Ask questions, understand if you get a private room, or a semi private room should you need to be hospitalized.

Ambulance. Many times if you’re going back and forth between two health insurance policies because they are similar in price and benefits, one of the benefits I always look at is the ambulance benefit. It’s one of the small things we forget about when we buy a health insurance plan. Some will cover air and ground transportation, some will only cover ground transportation. Typical benefits here run from $2000 to $5000. I just happen to like knowing how I’m getting to a hospital, should I ever need to go.

Maternity Benefits. This is a very important benefit if you are planning a baby in your future. You would be surprised to find out how many health insurance companies no longer offer this coverage. If they do, you will pay a extra premium for maternity benefits. Many health insurance plans will only cover complications due to pregnancy, and not the actual child birth. If this is an important benefit to you, make sure you understand what you’re buying.

Organ Transplants. While this coverage benefit doesn’t come up often, it’s a good idea to compare this benefit in your health insurance policy as well. Some health insurance companies will place a cap on the amount they will pay for a transplant, others will pay the full amount regardless.

One last quick comment. The benefits, and options discussed here all pertain to using in-network providers approved by your health insurance company. Please be aware that if you ever have the need to use an out-of-network service provider your costs will be higher. Also keep in mind many health insurance companies will have a separate deductible, or increased co-pay, that many times will be in addition to your annual deductible, or co-insurance to use these services. Out-of network emergency services are usually treated as being in-network.

I hope by now, you have a better understanding of what is included in a health insurance policy, and what questions to ask of your health insurance agent when you purchase your plan. I’ve enjoyed putting this web site together, I hope you’ve enjoyed reading it.

If you ever have any questions, or comments, about a health insurance policy, or this web site, or life in general, please feel free to place a comment on my blog and I will respond to your inquiry.

Thank you, and may you enjoy a healthy and prosperous future.