Do you think you pay too much for health insurance? This might be the case. How can you know for sure? Below is a list of indicators that could be driving up how much you spend on healthcare each year. If yo
ur health plan includes any of the below “benefits”, it might be time to re-evaluate. These indicators could explain the overwhelming aggravation, expensive physician bills, and the confusion you feel while attempting to navigate the system.
Applies to Deductible or after Deductible
In your benefits handbook, there may be language stating “applies to deductible” or “after deductible” in reference to the terms of your health insurance benefit booklet. Both of these phrases mean you must pay your deductible prior to receiving any financial help from your health insurance. If your insurance lists “applies to deductible” for office visits, prescriptions, wellness, or other outpatient services, this could be financially significant. Anyone with a high deductible plan will likely pay $1,600 each year before the health insurance pays anything for your medical care. Once you add your monthly premium into this calculation, the result can be a disturbingly large amount of money.
You could pay hundreds or thousands of dollars before the health insurance covers any costs. The worst part is the deductible starts over each year, whether or not it you paid or “met” the amount for the year prior. If you have a health plan with a deductible that applies to routine care, it might be better to look for another plan that states “co-pay only”. As the alternative of never going to the doctor and/or pharmacy will only result in higher healthcare costs down the line.
Co-Insurance is over 20%
Your deductible outlines how much you pay before health insurance starts pitching in for the costs; however, the co-insurance is equally important to understand. Co-insurance is the amount still owed after the insurance pays. If you have routine care where co-insurance applies, it may get expensive. Most plans are 80/20, meaning the plan pays 80% and you pay 20% of the healthcare costs. If you are lucky, this only “applies” or is listed under inpatient services. However, one hospital admission is roughly $12,500 for adults (subject to variation by area), so your responsible shared cost could be $2,500, according to the Agency for Healthcare Research and Quality in 2013.
Prescription coverage only includes generic
There are a wide variety of prescriptions on the market, but most insurance plans offer larger discounts on generics. Prescription plans that only cover generics can be tricky. For example, a new prescription or brand most likely will not have a generic formula for a number of years following its release – as in the case of blood pressure medicine. There are countless types of blood pressure medicines, but there are some “designer” versions. These formulas include combining two drugs into one, or have added ingredients acting as enhancements for people with varying needs. If the plan does not cover or reimburse for brand name drugs, it can amount to hundreds of dollars owed at the pharmacy checkout counter.
No Out-of-Network Coverage
Health plans advertise a few key perks to members; one is the strength of their provider network. It is a list of physicians, hospitals, and other facilities that participate with the plan, which members can access to utilize their health services. The problem arises when you need a doctor who is not signed up with your plan, aka “out-of-network”. Any provider that is out-of-network that you visit will not be covered by insurance, ultimately becoming your financial responsibility. Unless it is authorized by the plan, which is a rare exception, the entirety of services rendered will be charged to you. Therefore, it is crucial to understand the out-of-network coverage offering that your health plan provides it could be nothing. Even a 40/60 out-of-network benefit is better than receiving nothing from your health plan.
Customer service is automated/phone tree
Teleprompts can offer a general overview of benefits and claims history with ease. However, when complex questions arise, you will often find yourself transferred from one customer service agent to another, each of which is unable to address adequately your specific problem. This process is never short with phone calls lasting anywhere from 15 to 30 minutes, sometimes more. In order to avoid the frustration of the phone tree, it is better to call during off hours, when you have dedicated time to be routed to a competent agent. Off hours in this case would be 9-5, while most people are working. The process, unfortunately, is very similar to calling any company with agents.
Have questions on how to select a better health insurance plan, email our advisers at healthcaredeciphered@gmail.com. Even if you have employer-based insurance, we can help!