Breakdown of Health Insurance Costs in District of Columbia
You may have heard the term “premium” when it comes to health insurance. A premium is the amount of money you pay monthly to have health insurance coverage. Whether you use your insurance or not, this money is never returned to you. Another familiar term is “deductible.” This is the additional money you are required to pay to any healthcare providers before your insurance company starts to make their promised contributions for any medical costs.
Keep in mind that deductibles are different from out-of-pocket costs. A deductible is an annual financial responsibility but out-of-pocket refers to how much you have to spend before your insurance company will pay 100% of your bill.
Deductibles and out-of-pocket costs typically reset each year, with the previous year’s expenses having no impact moving forward. So if you have a deductible of $5,000, for example, and you spent $3,000 out-of-pocket last year and your insurance renews with the sample plan in place, your out-of-pocket expenses are reset to $0 and that $3,000 from last year does not roll over. However, some plans in District of Columbia offer an exception to this rule and allow a rollover of your paid deductible amount from the previous year into the first quarter of the new insurance year.
Co-payments, also known as co-insurance, refers to your financial obligation of a medical visit or service. If your co-payment for visiting a primary care physician is $25, then every time you see your primary care physician, you pay $25. From there the insurance covers the balance if the services rendered are within coverage on your plan. Co-payments are not applied toward deductibles.
You may also receive a lifetime benefit from your insurance company. This refers to the maximum amount of money that your insurance company will pay in total for your healthcare. Medical claims will no longer be paid by the insurance company once this maximum amount is reached.
Your employment has a significant impact on the health insurance plans that are available to you in District of Columbia. Working for a large company will likely qualify you for their group health insurance plan. This is usually more affordable than getting individual healthcare, but no one is required by law to participate in these group health insurance plans.
Being self-employed or unemployed presents the option of purchasing private, individual health insurance. If you are a senior and do not work, you are eligible for government financial assistance through Medicare. Low income individuals can apply for government assistance as well, which is called Medicaid.
It is important to check with your doctor to see which health insurance plans they accept in District of Columbia if you want to continue visiting a specific physician. Notify your doctors if your insurance plan changes, and be sure to check with your insurance company regarding any specific questions or concerns about your coverage.