November is a big month for renewing insurance plans. A lot of patients come into the office with insurance questions and over the years I have become fairly adept at reading insurance plans. It used to be very simple, what was the co-pay, did I have prescription coverage and what sort of flexibility did I have if I am in a jam somewhere far away?
Now the categories have gotten much more complicated. Take a look at some of the areas of concern:
- Co-pays…now $25 and up is the norm. Many plans also charge upwards of $45 for a specialist…
- Deductibles…do you need to meet a deductible before the plan will cover anything…is it a hospital only deductible?
- Out of Pocket Maximum…these can range from nothing to $5,000 per individual
- Prescription coverage…are name brands covered or must you get generic? Is there a prescription deductible…different co-pays for different levels of drugs.
- In network vs out of network…go to the hospital and have an x-ray taken…the x-ray is covered but is the radiologist who is reading it? That makes for a nice surprise when that bill shows up at home.
- Plan limits… Did you know there may be a lifetime maximum of how much the plan will cover?
- Service limits…love your chiropractor, how many visits will the plan cover?
- Lastly co-insurance…this one is nasty with a capital N.
The new thing in insurance plans is co-insurance. Allow me to explain how that works. You go to the hospital for a procedure, let’s say a gall bladder removal. Total cost of said procedure is $20, 000. You pay your co-pay and head home. Two weeks later a bill shows up in the mail for $7000. 7 GRAND!!!! Welcome to your 35% co-insurance. Now every plan is not that bad; I have seen this range from 10%-35%, but as you can imagine, this could get expensive.
You must be very diligent when picking your insurance plan. Please check all of the categories above, especially the co-insurance category before making your decision.
If you have any questions please hit the contact us tab and we will be very happy to help you. If you are local to me, please bring the plan sheet over to my office and I will gladly walk you through your options.