Meeting Health Insurance Deductibles: Why You Shouldn’t Wait to Get Services

The Realities of Health Insurance Deductibles

In many cases insurance policies align with the calendar year and deductibles renew at the start of every year. The cost of medical care and services can come as a shock to many Americans, and there is an unfortunate lack of knowledge when it comes to health insurance and its benefits. Many people seeking medical attention and assistance will not pursue service as they are discouraged by their deductible, and insurance will not pay for these services until the deductible is met. For many Americans, this means they are paying for coverage monthly without truly reaping the benefits. This not only fails to serve the consumer financially, but also medically as they fail to pursue what might be urgent assistance from medical professionals.  If these individuals could just meet their deductible earlier in the year, then their insurance would pay toward the services throughout the year. Many people find themselves compelled to wait until the end of the year once their deductible is met, but by then, many providers are booked far out and patients are unable to be seen before the new year. Before you know it, another year has passed and many Americans have overpaid for services they didn’t have access to, and this cyclical paradox continues. While many patients do this in an attempt to save money, it is incredibly important that patients pursue medical attention on a regular basis for preventative reasons and in emergencies. Money shouldn’t be the reason people are without these services. 

What is a deductible?

The US government defines a deductible as the amount of money you pay for covered health care services before your insurance plan starts to pay. So, for example, if your deductible is $1,500 you are responsible for paying the first $1,500 of qualifying services yourself. After paying your deductible, services can be waived completely or reduced significantly leaving the individual with only the responsibility to pay a copayment or coinsurance. The insurance company pays the difference After you pay your deductible, you usually pay only a copayment or coinsurance for covered services. Some plans will pay for particular services like Checkups and Disease management programs before you meet your deductible. All marketplace health plans will pay for certain preventative benefits like shots and screening tests as well, while other plans have separate deductibles for certain services like prescription drugs and family plans often have an individual deductible that applies to each person, and another to the family. The general rule of thumb is that the lower your monthly premium is the higher your deductible will be while the higher monthly premiums have lower deductibles. Generally, plans with lower monthly premiums have higher deductibles. Plans with higher monthly premiums usually have lower deductibles.

Recent changes to health insurance

• Children can stay on their parent’s health insurance until they are 26 
• Insurance companies are no longer allowed to deny new applicants based on their pre-existing medical conditions 
• Insurance companies may not cancel an individual’s insurance if they become sick
• Insurance companies cannot set limitations on how many bills they will pay for on someone’s insurance bill
• Preventative care is now free
• You can buy your insurance in the Health Insurance Marketplace, previously if your place of work didn’t provide insurance, each person woudl be responsible for getting their own insurance which wasn’t cost-efficient. 
• There is now a universal price and expectation of service for all health insurance plans. 

Ways People receive health insurance

There are several ways people might receive health insurance. Many Americans receive health insurance as a perk or benefit of their job which is very helpful. They may receive this at no cost at all or pay a reduced cost every month. Others utilize Medicaid which is provided by the state in which they reside. In addition, there are insurance plans based on age such as medicare for seniors 65 and older or the Children’s Heal Insurance Plan (CHIP). Each of these has particular requirements and there is a large number of the population that is left to pay for insurance out of pocket without very costly assistance. 

Premiums and Copays

Premiums and copays serve as the two different types of costs that occur when you have health insurance. A premium is an amount you pay to your insurance company each month in order to obtain insurance while a copay is a set amount of money you have to pay each time you receive medical care. Each plan has a different copay but some have none at all. Part of the process of choosing an insurance plan has to do with determining if you want a high or low premium which will determine what kind of copays you can expect. 

Deductibles and Co-insurance

Some insurance plans have deductibles. This is a predetermined expense that you are expected to pay before the insurance company starts to pay for particular services. Depending on your insurance, you might only pay for a percentage or a part of your healthcare costs. Coinsurance varies based on the premiums you’ve selected, so for example; should your insurance pay for 70% of MRI costs, and your charge is $100 then insurance will pay $70 and you will pay the remaining balance of $30.

There are many resources you can visit for more information about your eligibility for particular insurance services that will be listed below. These resources address frequently asked questions and offer insight into the intricacies of Health Insurance. It is our hope that this information allows you to seek health insurance and medical assistance if needed. If you are a current holder of health insurance it is strongly advised that you seek medical assistance and attention when you need it; don’t let your deductible be the thing that stands in the way of you receiving the help you need. 

For more information visit HealthCare.gov

 

References 

 

Mental Health America: How Insurance Works

https://mhanational.org/how-insurance-works

 

Department of Health and Human Services: Health Benefits and Coverage.

https://www.healthcare.gov/coverage/what-marketplace-plans-cover/