June 2019

INTRODUCTION

ISMS understands that the cost of health care is a major issue for many patients, and that medical professionals can play a key role in helping patients understand those costs. There are many tools available that can shed light on approximate patient costs for various treatments, but patients often need other education about insurance coverage and other issues before they can fully understand the relationships between their health plan, their care team, and their own financial liability.

This resource is designed to help health professionals walk patients through a complete understanding of how health insurance works; what their particular plan covers, and how its cost-sharing provisions are structured; how to find cost estimates for specific treatments and bundles of care; and how to bring all this knowledge together to make informed decisions about their care.

UNDERSTANDING HOW HEALTH INSURANCE WORKS

Many patients believe they have 100 percent "full" medical coverage. But some plans may offer only limited benefits, and most plans require patients to share the costs of their care in various ways. Variables such as deductibles, coinsurance and co-pays will impact the level of reimbursement for which the plan is liable, so before trying to understand their out-of-pocket costs, patients will need to understand how their particular form of health coverage works. It is important for patients to be in contact with their insurer to fully understand the deductibles and co-pays for which they will be responsible.

To view this Issue Brief in its entirety, click Get Resource.