In many countries, the cost of health care is provided by the government. In the United States, individuals are responsible for the cost of the health care that they get. To assist Americans in paying for these services, health insurance is purchased by almost all Americans. It is important to remember that not all health insurance policies are the same, and that most do not cover 100% of all services.

 

Purchasing Medical Insurance

  • When you purchase health insurance, there are a wide variety of options.
  • The options that are chosen determine the cost (or “premium”) of the health insurance policy.
  • Some of the options you can choose from:
    • effect where you can get medical care
    • what kind of care is covered
    • how much the care will cost you
    • what types of medications and treatments you can have
  • It is important that you are familiar with the health insurance policy you have, and what it covers before you need health care.

Insurance Cards

  • Health insurance and prescription cards can often be printed off of the internet once the policy has been paid for. Some companies will mail the cards to you.
  • The health insurance card will be used when you get health care from medical offices, Rutgers Health Services, testing facilities, emergency departments and hospitals.
  • Your prescription card will be used to get prescription medications from the pharmacy.
  • You must keep these cards in your wallet and show them anytime you get health care or need prescription medications.
  • The back of these cards often have the phone number and internet site information for your insurance company.
  • You can contact the company to ask about your coverage.
  • The company may also have language translators to assist if needed, at no cost to you.

What is a Deductible?

What is a deductible?

  • It is important to understand that health insurance will not cover all of your medical expenses.
  • A “deductible” is the amount of money you must pay before the insurance company starts to pay any money.
  • For example, if you have a policy with a $50.00 deductible and had some lab tests done that cost $300.00, the insurance company will pay $250.00 and you will pay $50.00 ($300.00 minus your deductible of $50.00 = $250.00 for the insurance to pay).
  • Read your health policy carefully. Some policies have a deductible to be paid once a year; others have a deductible that must be paid for each separate illness or injury.
  • If your policy requires you to pay a deductible for each illness or injury, your healthcare costs could be much higher.
  • When using Rutgers Health Services as a fulltime student your visit deductible is pre-paid through your student fees.
  • Using services outside of Rutgers will usually require that you pay your deductible.

What is "Preventative Care"?

  • Preventative Care is designed to help keep you healthy and includes things such as routine physical exams, gynecologic exams and immunizations.
  • If your policy does not cover preventative care, you will be responsible to pay all of the expenses associated with the preventative service provided. This can be very costly, especially if you need immunizations which can be extremely expensive.
  • Often “deductibles” are “waived” or do not have to be paid, for preventative services.
  • You will want to check your policy to see what it says about your preventative care coverage and deductibles.

What is a "co-payment?"

  • A “co-payment” or more often called “co-pay” is the portion of your health expenses that your insurance company expects you to pay.
  • It is a percentage of the total cost of the visit or service, after the deductible is paid.
  • For example: if you had an x-ray done and the total cost is $250.00. Your insurance policy has a $50.00 deductible and a 20% co-pay. You would be responsible to pay $90.00 (your $50.00 deductible, and 20% of the remaining $200.00 balance or $40.00, $50.00 +$40.00 = $90.00).
  • For some insurance policies co-pays can be a set fee or cost for a certain type of visit.
  • For example, a policy may have a set fee or “co-pay” of $30.00 when you visit a general doctor, and $50.00 co-pay when you visit a specialist.
  • When using Rutgers Health Services as a fulltime student your visit co-pay is prepaid through your student fees.
  • Using services outside of Rutgers will typically require that you pay your co-pay.

Co-Payment for Medications

  • Policies often have set “co-pays” for medications that are “tier” based. The “co-pay” or price you must pay for the medication is based on the tier the medication is in.
  • A “tier” is a group of medicines that can be provided at a certain price.
  • Most policies have 3 “tiers”. Typical co-pays for medications can be $15.00 for tier 1, $30.00 for tier 2, and $50.00 for tier 3 medications.
  • Tier 1 medications tend to be generic medications which are very effective and the least expensive option.
  • Tier 3 medications are usually name brand drugs, and the most expensive option.
  • You will pay a co-pay for each prescription medication you get, each time you pick it up.
  • For example, if you need two medications that are tier 1 medications, you will pay $30.00 ($15.00 co-pay for each of the medications). If one of these medications will be a medication you will continue on, you will pay $15.00 each month when you pick it up.
  • Some medications, like certain birth control methods, may have no co-pay.

"In-Network" & "Out-of-Network"

  • Where you obtain health care can affect your “out-of-pocket-payment” or how much money you will have to pay.
  • Some insurance policies allow you to see any doctor you want to see. More often, insurance companies contract with healthcare providers and facilities to provide care for a group of patients.
  • Your insurance plan will cover more of the cost if you use the “contracted” or “in-network” providers and facilities.
  • Before you go to any provider or facility, you will want to ask if your insurance plan is “in-network” with them (or contracted with them).
  • If the medical provider or facility is not contracted with the insurance company, they are “out- of- network”. Typically your deductible and co-payments will be higher, and cost you more money if you use “out-of-network” providers or facilities.

What is not covered by medical insurance?

  • Most health insurance plans also include a list of “exclusions” or expenses that will not be covered.
  • Some things that are typically not covered by health insurance:
    • treatment obtained in your home country
    • injuries as a result of war
    • self-inflicted injuries
    • cosmetic procedures
    • anything that is not medically necessary
    • Be sure to check your policy to see what the “exclusions” are.

Getting the most from your insurance coverage

  • The more you know about how to obtain health care and how your insurance policy will help you pay for the care you receive, the better you are.
  • It is important for you to ask questions before you need care!