Sneak Peek: What doesn’t your health insurance cover?

Exciting news!Medically Underinsured

I was recently contacted by the fabulous website with some questions regarding health insurance and what it doesn’t cover. I have been approached many times with questions about health insurance, as it can be very confusing to navigate.

Did you know that the average age of a grandparent in the United States is 48? Neither did I. Grandparents, along with many other people, struggle with finding healthcare coverage for themselves and their loved ones.

We shared a lot of interesting information with Here is a glimpse at only a few of the many interesting facts we discussed:

  • Insurance is essential. Make sure to research and compare insurance policies before selecting a plan. Consider if the plan covers your prescriptions, physicians, and services you need or may utilize in the future. Make sure to use your medical life list when evaluating options.
  • If your insurance tells you that alternative therapies, such as massage or acupuncture, are covered services, make sure to find out what is required for them to be covered, how many visits are covered, and what health care providers you can see. Unforeseen costs can be burdensome, so make sure you know before you go!
  • A good rule of thumb to determine whether a service is covered by insurance is to ask yourself whether or not the service is a medical necessity? This can be tricky, but usually insurance companies say services such as travel vaccinations or massages are not a medical necessity, and therefore are not covered.
  • If you are receiving high out-of-pocket costs for services that are not covered, look for a plan that better suits your needs. If that’s not feasible, talk to your doctors and ask if they will put you on a payment plan or offer discounts for paying in cash.

For more information, check out the article today on and make sure to let us know what you think!

For more healthcare tips for you and your family, check out my workbook for dealing with caring for your children, as well as your aging parents: Life in the Sandwich Generation. Life in the Sandwich Generation is a workbook filled with information, tips and tricks for managing the demands needing to care for your aging parents, as well as taking care of your children. It details how you can involve your children in the process and how to learn more about your parents health and finances, while still making time for yourself and your spouse. You can find it here for only $10!

What is a deductible, coinsurance, and copayment?

Insurance PolicyIt can be difficult to understand your insurance. Deductibles? Copays? Out-of-pocket maximums? What does this all mean? Knowing what these terms mean can make the task of choosing the insurance policy a lot easier. It can also help you to ensure that the policy you are choosing is within your budget and you don’t get stuck with any unexpected costs.

Today, we will discuss what a deductible is, what a copayment is and what coinsurance is. Knowing these terms when choosing a plan, as well as when visiting your doctor, will save you a lot of time and money.

First, what is a deductible? A deductible is the amount of money that you must pay for services before your health insurance kicks in. For instance, if you have a $5,500 deductible you will have to pay that whole amount out of pocket before your insurance pays a dime. Due to this, it is often advantageous to find a policy that has a lower deductible. Most people will never meet that high of a deductible, unless there is a medical emergency.

This can make it tricky when choosing insurances, especially through the market place. Most policies with low premiums have high deductibles and vice versa. This can make these policies more desirable because you may only be looking at what you will pay each month as opposed to what you will pay when you actually use your insurance, so make sure you choose a plan that fits within your budget and needs. One important thing to know is that plans through the health insurance marketplace pay in full on preventative services, regardless of if your deductible has been met. It is also important to check if your deductible if plan wide or if it has separate deductibles for things such as prescriptions.

You may see “individual versus family deductible” as a part of your policy’s description. The family deductible is typically higher than the individual deductible. However, this can be beneficial in some cases. For instance, let’s say your spouse has a procedure that costs enough to meet the family deductible. This means that everyone else on your policy has met their deductible too, even without stepping foot in a doctor’s office. If you have several members of your family on one plan, it may be a good idea to look into a policy that offers those benefits.

Second, what is co-insurance? Co-insurance is the percentage of the cost of a covered health service that you pay once you have met your deductible. For example, if you have a 10% coinsurance you will be responsible for 10% of the services rendered and your insurance will pick up the remaining 90%. So you may be thinking, wow, this sounds awesome! And it is, especially if you have a plan with a low deductible and a good co-insurance percentage. But then what if you have a procedure with an astronomically high allowed cost, like a heart attack, for example?

This is where your out-of-pocket maximum comes in. The out-of-pocket max is the the maximum amount you will have to pay toward your insurance for the year. Once you meet that number your insurance covers the rest of your services. This is a good way to protect yourself in cases of catastrophic health events. Therefore, it is important to know what your out-of-pocket maximum is, especially if you are of the population who is at higher risk for these major health events.

Third, what is a copayment? A copayment is a set dollar amount you pay for a covered product or service after your deductible is met. For instance, if your plan has a $40 copayment on a visit with your primary care physician, it will cost you $40 to see your doctor, assuming your deductible has been met. Also, with some plans, the deductible does not apply to certain services. For example, many chiropractic plans just have a set copayment regardless of if your deductible is met. Furthermore, the amount of your copayment can vary per service on your plan like for prescriptions or specialist visits. Like with the deductibles, it is typical that plans with lower monthly premiums will have higher copays.

If you’re still having trouble navigating your health insurance pick up my books Easy Healthcare: Choose Your Health Insurance and Easy Healthcare: Obamacare. These books include everything you need to know about how to choose the plan that best fits your healthcare needs.

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Healthcare Benefits for Mental Health Services

psychiatrist examining a male patientIn terms of well-being, mental health is just as important as physical health. However, it has not always seemed that way in the eyes of the insurance companies. Previously, little emphasis was placed on the importance of mental health as a component of overall well-being. And a lot of insurance plans simply did not provide care for those with mental health issues.

Now, with the Affordable Care Act (ACA), mental health benefits have become more widely available to those in need. When the ACA was signed in to law in 2010 there were strict guidelines as to what each plan must cover. All plans were to include benefits such as maternity care, preventative services, and mental health care.

In terms of mental health benefits, all plans must cover three things: behavioral health treatment, such as psychotherapy and counseling, mental and behavioral health inpatient services, and abuse treatment. Also, you will not be penalized for a preexisting condition, such as depression. And thanks to the ACA, a majority of plans cover preventative mental health services, such as behavioral assessments and depression screenings.

This is all great news, but some people do not even know that their health insurance plans provide mental health care. Therefore, I have put together a list of things you should know about your coverage.

First, mental health issues must be covered equal than or greater than the coverage provided for medical or surgical treatments. This means that all copays must be equal across the board. Your charge for a visit with your psychiatrist is the same as an appointment with your orthopedic surgeon.

Also, there is no annual maximum in terms of treatment visits. Insurance companies are prohibited from putting a financial cap on treatments. However, they can limit the number of visits based off of medical necessity. Once you see a psychiatrist they set up a treatment plan, at the end of that treatment plan there is a reevaluation. If they feel your care still is medically necessary, your insurance is required to continue to pay for your treatment.

Second, all mental health diagnoses are covered under the federal parity law, whether it is a disease, such as schizophrenia, or a substance abuse problem. However, specific health plans are allowed to exclude certain diagnoses in any area of mental or physical health.

Third, it is important to remember that not all doctors take your insurance, even if you have mental health coverage. A lot of mental health providers are “not in network” with many insurance companies because their reimbursement rates are so low. Therefore, it is important to check if a provider is within your network before scheduling your first appointment

It is extremely important to know and to understand what your insurance company covers. Also, before you schedule your appointment you should call and find out what your deductible is, what your copay is and any other pertinent information. This will help you to save money and to save time.

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