Health insurance answers
Whether you’re new to your current health insurance plan, new to health insurance altogether, or you’ve had insurance for a long time, there’s a lot to learn and understand. Here are the top questions members like you have asked the HealthPartners Member Services team.
1. What’s a copay?
A copayment, or copay for short, is a set dollar amount you pay when you receive medical services. For example, it might cost $45 to visit the doctor, or $25 to get a prescription.
2. What’s coinsurance?
Coinsurance is the percentage of a bill you’re responsible for. For example, 20 percent coinsurance means you pay 20 percent of the cost of care and your insurance plan pays the other 80 percent.
3. What’s a deductible?
A deductible is the amount you’re responsible to pay for care before your insurance plan helps cover costs. So if you have a $1,000 deductible, you’ll need to spend $1,000 toward eligible health care before your insurance plan helps pay for your costs.
After you reach your deductible, you may still be responsible for copays or coinsurance.
4. What’s an out-of-pocket maximum?
This is the most you’ll pay for care during the plan or calendar year, depending on your plan. This cost usually includes your deductible, coinsurance and copays. (You’ll still be responsible for your insurance premium bills.) After you’ve reached the out-of-pocket maximum, most plans will pay 100 percent of your in-network eligible health care costs.
5. How will I know when I’ve met my deductible or out-of-pocket maximum?
6. How do I know which doctors are in my network?
HealthPartners selects health care providers who offer high-quality care at the best possible price to be part of its provider network. Because of this special relationship with those providers, your costs are usually lower when you choose in-network care.
Sign into your online account or myHP app to find doctors in your network. All of the doctors you see are part of your provider network. You can also contact HealthPartners Member Services to find information about your network.
7. How do I know if my annual checkup is covered?
Preventive services, like checkups or routine screenings, are usually covered 100 percent by your insurance (unless you have what’s called a “grandfathered” plan). Sign into your online account to check your benefits, or contact Member Services. You can find out more by reading our preventive care frequently asked questions.
8. What’s a formulary?
A formulary, also called a drug list, is a list of medicines covered by your health plan. It tells you generally how much you’ll pay and any requirements that need to be met before you can start a medicine.
9. What’s an Explanation of Benefits, and how do I know how much I owe?
Clinics and hospitals send a bill (“claim”) to the insurance company before patients get their own medical bill. After HealthPartners processes a claim you’ll receive an Explanation of Benefits (EOB). This document isn’t a bill. It’s an insurance document that tells you:
- That HealthPartners received a claim from your provider
- Which discounts were applied to the total cost by your insurance plan
- Any amounts your insurance plan paid toward the total cost
After you receive an EOB, your provider will send you a bill. This has the amount you’ll pay directly to the provider. Your bill will also often have some of the information found on your EOB, such as the original cost and how much of it was paid for by your plan.
10. What if something’s wrong with my bill?
Because health insurance costs and spending are less straightforward than other types of purchases, it’s a good idea to look at the EOB and your bill.
- Make sure the dates and descriptions of services look correct
- Confirm that the information on your EOB matches the details found on your bill
- If anything looks incorrect, contact your doctor’s office first
If you have questions about how the medical services were covered by insurance, contact HealthPartners Member Services.
Have more questions? We’re here to help
These are just a few of the questions we answer every day. If you have more questions please contact Member Services and we’ll be happy to help.
This is general information intended to help most members. Sign in to your online account to see documents for your specific plan. If there is a difference between this general information and your plan documents, your plan documents will be used to determine your coverage.