HEALTH
INSURANCE

This can get complicated based on the plan you choose, but here are a few typical things to think about (this is not intended as an all-inclusive list):

• Deductible: This is the amount you must pay for health-insurance-related costs prior to your health insurance kicking in.
• Co-pay (co-payment): A fixed dollar amount within the health plan you pay up front, for a covered service.
• Co-insurance: An agreed upon percentage allowed for charges on covered services. For example, you may be responsible for 10%, while your health insurance carrier is responsible for 90%. This typically applies after you have met your deductible.
• Out-of-pocket maximum: There is a lot of variation in plans for this one in particular. Once you have reached your agreed upon maximum out-of-pocket expense with your health insurance carrier, your health insurance carrier will typically pay 100% of covered services. Remember, this does not include your monthly premium.

Each individual health insurance carrier has contracts with doctors, hospitals, laboratories, pharmacies, etc.; this is called their “network”. Remember the deal breakers we discussed above? This is typically the most important deal breaker we hear from our clients. It’s not uncommon for doctors to enter and leave health insurance networks. It’s best to ask your doctors’ office which network and provider options they carry.

Open enrollment typically starts in the fall and goes through mid-December. But if you have a qualifying event such as marriage, had a baby (or adopted), change in residence (move from one zip code to another), etc., you may be eligible for a special enrollment period. A special enrollment period is open for 60 days after the qualifying event.