Navigating Insurance and Primary Care in Maryland: What You Need to Know
Understanding your health insurance plan may seem confusing, but the top primary doctors in Maryland, at First Medical Associates, want to make sure you know how to navigate your insurance plan and understand the various terms used, so you have no unexpected costs. Insurance plans are all different, they all determine which providers you can see and how much you are going to pay. The following terms are all important to learn to understand your insurance benefits.
Important Insurance Terms
Deductible
The amount you must pay for covered health care costs before your insurance begins to pay.
Premium
This amount you pay for health insurance coverage, typically paid monthly.
Copayment
Each insurance plan establishes a set co-pay amount for each service provided, for example doctor visits, you pay the co-pay amount.
Coinsurance
Each insurance plan establishes a percentage (usually 20% or 10%) of costs you pay for services after you have met your deductible until you meet your out-of-pocket maximum.
In-Network or Out-of-Network Providers
Each insurance plan contracts with specific doctors, hospitals, and medical suppliers to provide health care services, they are in-network providers. Seeing any doctor or staying in any hospital who is not on the contracted provider list (out-of-network) will result in higher costs for you. Each insurance plan will establish the percentage of coinsurance you will pay for in-network vs out-of-network providers.
Out-of-Pocket Maximum
Each plan establishes an out-of-pocket maximum for the plan year, that amount is the most you will have to pay for any covered services for the rest of the plan year. The insurance will cover 100% of those services once you have met your out-of-pocket maximum. Once you have met your out-of-pocket maximum, you no longer pay any coinsurance for covered expenses for the rest of the plan year.
The various amounts mentioned above: deductible, co-payment, coinsurance, and out-of-pocket maximum are all dictated by the type of insurance plan you have. Typically, a higher premium means a lower deductible and lower out-of-pocket maximum; a lower premium means higher co-pays and a higher deductible.
First Medical Associates is contracted with most medical insurance plans, so typically they will be an in-network provider for most patients. One simple phone call to our office and you will know whether we accept your insurance. We also are always careful to discuss with our patients any services we are going to provide, and we work closely with your insurance company to let you know whether the services are covered and what your out-of-pocket costs will be.
We take your health seriously at First Medical Associates, and that means ensuring you have no unnecessary stress from unknown medical expenses. We are careful to disclose all costs you will be responsible for before we provide any services. Call First Medical Associates today to find out whether we are an in-network provider and schedule your first appointment.