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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.

For more healthcare news and tips daily follow us on Twitter, Facebook & Instagram.

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Helpful Healthcare Links for May 26, 2016

Slim waist with a tape measure around itThere’s a lot going on in healthcare news this week! I have put together a handful of trending topics to share with you in hopes that this information will assist you in maintaining a healthy lifestyle. Here are a few articles for this week.

Obesity is an epidemic in the United States. Almost 55 million American’s are considered overweight or obese as determined by body mass index (BMI), which is a weight-to-height ratio. However, this number may not always be the most accurate representation of your overall health. Here are four other factors that can give you a much better idea of if you are at a healthy weight. 

You hear a lot about clean eating now a days. To simplify it, clean eating is eating food in its pure, whole, natural state. However, this can be challenging. It can be expensive, time consuming, and difficult to stick to in a social manner. Follow these clean eating basics, and it will be easy to keep it up.

According to a recent study people are starting to live longer, which is not surprising due to advances in healthcare, improved hygiene and sanitization, and improved nutrition. Since people are living longer, there is more of a need for long term care, such as assisted livings and nursing homes. And as the need increases, so does the price tag. Follow the link below to find out how much long-term care will cost you in the year 2016. 

Exercise and physical activity have a positive effect on the brain. Sometimes when you’re feeling down it is nice to go for a walk or a bike ride, or head to the gym and lift some weights. This is not your imagination, it’s science. Endorphins, chemical signaling molecules in the brain, are released during exercise. The endorphin rush felt during exercise can help ward of depression and Alzheimer’s disease.

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 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, 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!

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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.

For more healthcare news and tips daily follow us on Twitter, Facebook & Instagram.