The cost of your healthcare extends beyond the price you pay for insurance premiums each month. Health insurance, whether it is provided as an employee benefit or is purchased independently from a state or federal Exchange, is only the tip of the iceberg when it comes to protecting you from costs you might need to bear. Nowadays, almost all health insurance plans carry a deductible, the amount of your health care you are required to fund each year before your insurance pays a dime. Additionally, high deductible health plans are becoming more common with employers and may be the only plans available on the Exchanges. This means that you, the subscriber, will shoulder responsibility for even higher costs of medical care. If you have a high deductible plan, it is in your best financial interest to understand exactly how your policy works. Here are 4 easy steps in ensure that you are getting the most from your high deductible health insurance benefits.
1. Take advantage of free services
While your plan might make you responsible for thousands of dollars of medical care, most plans include some level of routine “wellness” screenings that are free to you. These can include a yearly wellness check-up, mammography, vaccines, and colonoscopies, to name a few. You should confirm with your insurance provider which screenings are free to you, and then be sure that you avail yourself of them. Be careful to conduct these services with an in-network provider, and to investigate the definition for that screening, or that “free” service might cost you hundreds if not thousands of dollars. What one policy defines as a yearly wellness check-up might differ significantly from what your doctor includes as standard of care for that exam. The difference between those definitions could translate into significant cost for you to bear.
2. Shop the price
While pricing for medical services is anything but transparent, it is important that you ask the right questions to ensure that you avoid unexpected medical bills, or worse, incur medical debt. Before seeing a doctor or undergoing a test, ask the facility for the codes that will be billed for the services provided. Then contact your insurance provider and let them know which facility you will be visiting, provide them with the codes that will be billed for those services, and then ask them to let you know what cost, if any, you will be responsible to pay. Be sure to take detailed notes on the response, including the name of the representative and the date and time of the call, in case you run into a medical billing error. The insurer is the only party that can definitively confirm your financial responsibility for services under your policy.
3. Be aware of the start date for your plan year and start using benefits early
Since your deductible resets at the beginning of each plan year, it’s important to know exactly when that starts. Not all insurance plans begin on January 1. If you assume that your plan year starts January 1 when it actually starts October 1, you might mis-time scheduling free screenings. Or worse, you might not maximize the benefits your insurance would pay. If you know that you need an expensive procedure, it would be best to schedule it early in your plan year so that should you need care later in the year, you will already have met your deductible and your insurance should then pay for the subsequent care, minus any copays/coinsurances.
4. There are limits to your out-of-pocket costs
While high deductible plans can be expensive, they are not without limits. All 2017 plans on the Exchanges have a maximum for out-of-pocket expenses. Most employer plans, as well, limit your financial exposure. So it’s a good idea to confirm what those limits are at the start of the plan year…and be sure you seek in-network care, since limits don’t necessarily apply to out-of-network care.
For more information on this topic, or any other financially-related health topic, visit www.get-meducated.com. Our medical claims advocates would be happy to provide guidance through a free consultation.