The New Year provides a chance to connect with your health insurance company and it’s always a good idea to do just that! Insurance plans change benefits and the services they cover annually. Healthcare insurance continues to change so it is imperative that everyone stays vigilant regarding his or her coverage and deductible amounts.
’This is covered by your insurance.’
A phrase we have heard all too often, but this can be tricky! ‘Covered’ means that your insurance company accepts the charge and will process it according to the contract they have with the providers. However, that does not necessarily mean you won’t have an expense on a covered service. If your insurance plan has a deductible and co-insurance provisions, covered services may be applied to your deductible and co-insurance first.
For example, if your insurance has a deductible of $1,500 and the cost of your procedure/lab is $250, the $250 will be subtracted from the $1,500 deductible. Unfortunately, the $250 cost for the procedure will be money that you will have to pay your physician or facility. The insurance deductible will now be a balance of $1,250. So technically, it is covered, but any costs incurred until the deductible is fully met, will be out-of-pocket money for you.
Many plans cover physicals, labs, and procedures. The real question is, does yours? It is always a good idea to know your insurance coverage. If you don’t have access to a list, remember to take the insurance company’s ‘800’ phone number along with you so you can call to check on your coverage before you consent to a procedure or a lab that your doctor says you need.
A few tips that may help to navigate the insurance of today:
1. Call your insurance company and secure a list of the things your insurance will cover.
2. Look carefully at drug formularies. Many companies change how drugs are covered from year to year, or even during the year. Call the company to verify coverage. Also look into mail order pharmacies. There are times when they can be less expensive than going to a retail pharmacy.
3. Know the amount of your deductible! Understand that choosing the cheapest policy is not always the best. Sometimes cheapest may mean coverage is limited and more financial responsibility is placed upon you as the patient. A healthy person may be ok with a high-deductible plan because they do not use their insurance very often, but someone who has chronic illnesses may have higher medical costs and therefore may need more coverage with the insurance chosen.
4. Consider utilizing a health savings account if you have a high-deductible plan. Check to see if your employer participates in a plan like this. It is tax deductible and may allow a certain amount to be carried over to the following year.
5. Know the penalty for not having insurance. The penalty for 2017 is $695 per adult and $347.50 per child or 2.5 percent of your income, whichever is higher. Those who do not have access to affordable insurance will not have to pay a penalty.
6. Stay up-to-date with the latest health care information. Sign up for email and text message reminders to get important health coverage information.
Understanding your insurance coverage is your responsibility. It is impossible for your physician to keep abreast of all the insurance plan details to know exactly how it will affect you financially. Prior to procedures or labs that your physician may require you to have, check with your insurance company to understand the coverage and if you will be financially responsible for the balance.