What Are The Hidden Health Insurance Benefits You Are Not Aware Of?

Still paying for the procedures and prescriptions you have already paid for? Why? Because you just agreed but never actually went through the fine print of your health insurance policy; and to be honest, most of us haven’t.

The gym membership, Lasik surgery procedure you’ve been pondering upon may be covered in your health insurance policy. Or maybe nursing mothers can get heavy discounts on breasts pumps and other things. Well all this while you were just saving for the wrong things that were already paid for.

What Are The Ways to Pay Medical Bills With No Health Insurance?

When you have health insurance plan you are medically secured up to a great extent, this covers certain emergency trips to hospital and besides that you have many hidden benefits like different kinds of surgeries, gym memberships, 27*7 on-call doctors and nurses etc. But when you make the decision to go without medical insurance you need to be extra careful and be prepared to deal with the consequences. Medical care is very expensive and whether planned or unplanned you will be solely responsible for paying hundred percent of your medical bill. Now a day with even rising cost of health care, people find it difficult to afford health care costs even with insurance. Therefore, it is very important to be proactive because medical bills can lead to bankruptcy and certain measures need to be taken for good medical health care.

Shop for Doctors, Urgent Cares, and Hospitals

If you are not tied down to a health care insurance company yet, then it is worth to do some background check and make some necessary calls before putting your hard earned money somewhere. Different hospitals, doctors and private clinics charge different fees for first time visits, regular appointments and emergency visits. Call around and get to know the average fee for an appointment before you get sick, so that you know which one provides you the best care with the budget you have. There are different prices for different procedures in all the hospitals. So do all the background checks and get all the information before you take any decision regarding your health care plan.

 Ask for Reduced Rates or Pay in Advance 

You need to ask for a discount in the doctor’s hospital if you want lower rate on your medical bill when you don’t have a health insurance plan. Although if you pay in advance for planned surgeries like Lasik surgery and planned procedures like baby delivery you may get some discounts. This option is available for medical tests and prescriptions as well. Although it is not at all helpful in case of emergencies, but can surely save you a significant amount on your medical bills. But it is always a better option to be prepared when it comes to your health.

Call and Pay in Cash

Waiting for a call from your doctor’s office to talk about the payment procedure? Well do not wait for a call because the hospital may send you to a collection agency in as little as ninety days. Once you receive your hospital bill you should immediately call and set up a payment procedure plan according to your own conditions, because once you go to the collection office it is not at all easy to negotiate the amount and terms to pay the hospital bill. Usually hospitals and many doctor’s office lower the payment amount if you can make the payment right away or at least discuss the terms and conditions.

Save on medications 

Doctors at the hospitals and even private clinics have samples for the prescriptions that they prescribe. You can ask for the free samples when the doctor gives you a prescription. In addition to cut down and save on drugs you can ask for generic drugs at pharmacy or drug store and from your doctor. The drug companies can help you get the medicines or your prescriptions refilled at a price you can afford, once you qualify for help with a prescription assistance program. Many pharmacies offer some prescriptions at less price, also supermarkets like Walmart has list of various medicines which are offered at some reasonable prices. Try to get the list and get yourself medicines prescribed from that list only.

Set Up a Savings Account to Cover Medical Expenses

If you choose not to go up with some health insurance plan, the other best way to cover for your medical bills or any emergency is to start saving. Start saving some money every month money and will help in medical bills. Though this may not be enough when an emergency is there and you may even go bankrupt in order to pay for your medical bills. In addition to this there are other fines under the Affordable Care Act, therefore you need to save for those as well. These fines are per person in your family.

 Consider Getting Insurance

Why ask for a discount, or calling and finalizing various charges for doctor’s regular, first time and emergency visits. Why waste your time on finding special drug stores which give you subsidized rates or having generic prescriptions? When all you have to do is get in touch with a good health insurance company and finding a good health insurance plan. Health insurance is something that you need. It should be considered a necessity because it protects you from medical bills and allows you to seek medical care when you need it, which can prevent small problems from turning into more serious ones. Health insurance can be proven to be actually more efficient and pocket friendly. A health savings account allows you to make contributions to use towards your deductible and you will not be charged on any interest earned. The money in this account does rollover from year to year, which makes it easier to save for the long-term.

Better Understanding of Health Insurance

One of the most important investments we make is in Health Insurance. All the expenses of the hospital in case of illness, injuries and other needs can be extremely expensive if regular visits or other serious measures are required. Having a health insurance is the sole way to make sure that we are not out of resources when we are stuck in a medical situation.

Even though we are aware of this fact, but still a significant percentage of the population is living without a health insurance. According to Kaiser Family Foundation, more than 47 million adult Americans, which is 15% of total country’s population were not insured back in 2012. Such individuals have to pay approximately one-third of the medical expenses from their pocket, therefore medical expenses are more troublesome to them than the people who are insured. CNBC had an article published in 2013, due to medical bills that year, more than 2 million U.S residents were facing insolvency. A report from Becker Hospital CFO told that the hospital generated an income of $387.3 billion in 2011, which is $10,000 on an average per visit.

You should have a complete understanding of how health insurance works if you want to take advantage of it to the fullest. In this article, most basic concepts of health insurance are discussed, also the most common sources of insurance are also mentioned. The objective is to simplify the policies and increase the knowledge about the same along with presenting all the options you can discover.

Glossary

Let’s discuss a few basic definitions because having knowledge about important terminology related to health insurance is the first step to develop understanding and get the best suitable plan that serves all purpose to you and your family.

  • Premium: The amount which is paid by you every month or every year to a health insurance company for the health coverage.
  • Deductible: The amount of money you pay from your own pocket before the coverage plays its role. Most of the time the deductibles are round off amounts, such as $500 or $1000. Usually, the lower the premium, the higher the deductible is.
  • Coinsurance: Once the deductibles have been settled, the amount that has to be paid by you to the medical provider. It is usually a predetermined percentage of the prepared bill. If the policy’s co-insurance is fixed at 25% and the bill is calculated to be $100, the policyholder owes $25 in co-insurance.
  • Co-pay: this plan is similar to co-insurance, but with one key difference: your co-payment is fixed in the policy, so even before the payment of deductible you may pay your co-payment. For example, your co-payment is fixed at $30, so you will have to pay $25 each time you see a physician.
  • Out-of-pocket maximum: The money that is paid by you for the deductibles and coinsurance in a given year before the insurance company starts paying for all covered expenses.
  • In-network: The medical services providers and the services covered by the insurance plan. It is generally the most reasonable option for policyholders. Insurance companies have their business tie-ups with these medical service providers and they have negotiated lower rates with in-network providers.
  • Out-of-network: The medical services providers and the services not covered by the insurance plan. The difference between in-network and out-of-network providers is that the latter one is more expensive than the former one. This is because they do not have cost negotiated at lower rates.
  • Pre-existing condition: any disease, disability or any other chronic condition that exists at the time of getting insured. Also, the symptoms and ongoing treatment for previously existing condition make premium to be higher than that of the usual plans.
  • Waiting period: When you get employed, the employer-sponsored insurance plans have a waiting period which enables you to get ensured only after a specific period of time.
  • Enrolment period/ Open enrolment: The period of time during which you can apply for health insurance or change your plan or include your spouse/children in the insurance plan. It is difficult to alter your policies until the next open enrolment, although there is an exception if there is a life event. These life events include marriage, divorce, the birth of the child, change in household income, or relocation.
  • Dual Coverage: The policy plan of more than one insurer. For example, a married couple receives coverage from both their employers.
  • Coordination of benefits: When policyholders of two or more policies make sure that the beneficiaries do not receive more than the combined payout for the policies.
  • Continuation of benefits: It is nothing but an extension of a policy which no longer covers an individual under a particular plan. It is mainly used to cover the former or retired employees of a particular company that offers insurance coverage.
  • Referral: A notice from a veteran physician to the insurer that recommends specialist treatment for the policyholder.

WHERE CAN YOU GET COVERAGE

Health coverage plans are usually divided into two categories in the United States. You can obtain individual coverage for yourself or your families by contacting an insurer directly, the other option is to get group coverage as an eligible student or employee. Due to the arrival of the Affordable Care Act, the rules and regulations have been altered significantly.

Individual Coverage: initially the cost of policies varied depending on your initial condition. It is all because of the ACA that individual health insurance plans cover you irrespective of your previous health condition under this coverage plans you can choose your own physician, regardless of network. There are three coverage pathways:

  • Providers in ACA healthcare exchange
  • Providers not in ACA healthcare exchange
  • Short-term coverage policies

Insurers INSIDE the ACA Healthcare Exchange:

The ACA Healthcare Exchange was introduced by The Obama Administration to provide an online marketplace for health coverage buyers. There are five categories of the coverage plans:

  • Bronze: Policyholders have to pay 40%, co-insurance, plans will pay 60%
  • Silver: Policyholders have to pay 30%, co-insurance plans will pay 70%
  • Gold: Policyholders have to pay 20% co-insurance, plans will pay 80%
  • Platinum: Policyholders have to pay 10% co-insurance, plans will pay 90%
  • Catastrophic: Policy-holders have to pay 40% or more co-insurance, plans will pay 60% or less. This option is available for men and women under the age of 30 or the people who qualify for a hardship exemption. An exemption is granted to those people who receive insurance for more than 9 months but less than a year, U.S citizens living outside the country, and others who fulfill the criteria.

Most cost-effective plans are gold and platinum plans for those who want to visit regularly and need a regular prescription. Silver, bronze and Catastrophic plans are suitable for people who are at lower risk and do not visit a doctor regularly or frequently.

Insurers NOT in the ACA Healthcare Exchange: People who do not receive group coverage should apply to the individual plan, otherwise they might be fined each of being uninsured. You can always opt to get insured from insurance companies and not ACA Health Insurance Exchange. ACA Health Insurance Exchange has been introduced to simplify the process and options to choose from.

Your annual income matters the most while opting for an insurance plan, whether it is from an online portal or insurance companies. Individual who earn 400% of federal property level which is approximately $46,000 per year for individual pan and $ 94,000 per year for four-membered household or less are entitled to subsidies that will help them eventually to pay for insurance. But this subsidy plan is only available only on the exchange, in the offline market there is no such benefit. On the contrary, people who earn more than $46,000 per year may find an affordable health plan outside the marketplace. If you want to look for a suitable plan outside the exchange, it is advisable to approach an insurance broker. They will help you locate the best suitable plan for you that meets your requirement and suits your financial conditions. Also, just FYI their services are free of charge as they get their commissions directly from insurance companies, once the plan is sold.

  • Short-term Coverage:

    This plan is suitable for those who are uninsured and are waiting for their coverage plan to kick in. It is a cost-effective route for individuals. This is also known as gap policy. Short-term coverage rates start at 85 cents per day. But most of the times, short-term coverage does not fulfill the requirements of ACA.

  • Group Coverage:

    It is different from the individual coverage plan. In the individual plan, you are supposed to pay for entire premium but in group coverage plan premium is divided between the beneficiary and the institute that provides insurance i.e., a company or educational institute). Group network coverage plan holders are bounded in a physician network but they cannot be denied the preexisting condition’s coverage.

  • Employer-sponsored coverage: 

    More than 50% of the monthly premium is paid by the employer. Like the subsidy is available for individuals who get insured from the exchange, similarly, businessmen are entitled to tax benefits for providing group coverage to his employees.

Group coverage plans are cheaper than individual coverage plans because in the case of group coverage plans employer bears most of the premium. It is the choice of the employee if he wants to shop for policy in the ACA Exchange or get insurance through his employer. In most of the cases group, coverage plans are more cost-effective. There is a difference for the individuals who want a specialist/physician out of the network or who needs the prescription which is not covered under the plan.

  • COBRA

    COBRA, known as The Consolidated Omnibus Budget Reconciliation Act provides continuation of coverage plan for a certain period of time to those who have lost their group coverage plans under certain circumstances. These plans are more expensive than short-term or individual plans as the subscriber has to pay the full premium. Circumstances under which a person can get insured under COBRA are;

  1. Individuals who are fired or who have quit their job
  2. Individuals whose working hours are changed which has eventually changed the availability of the insurance plan
  3. Individuals switching their jobs
  4. Death, divorce, marriage, the birth of a child or any other life event.

FINAL CONSIDERATIONS BEFORE CHOOSING A PLAN

The final decision you take depends on various aspects, it should suit you and your family’s needs. The factors you should consider are:

HEALTH BENEFITS

It is important to know if there are restrictions in the plan you are opting for. The actual idea of a policy is to enable you to receive medical services whenever needed, but some insurers limit your doctor visits whereas some are lenient enough to allow doctor visits whenever required. Before enrolling in a plan make sure there are no as such restrictions.

COSTS

Are you one of those healthy individuals who make sure they get one yearly health checkup? If you answer is yes, you must get a high-deductible plan with a low premium will be the best option for you.

Do you have a condition that needs treatment and a large amount of money for the same? If so, you will need a low deductible plan, you will have to pay high premiums but you will save more on out of pocket expenses.

PHYSICIANS AND SPECIALISTS

If you are currently visiting a physician and you want to continue your treatment with the same physician then you need to check the network of doctors of your policy. The cost may differ if your doctor is out of that network, it may make your policy expensive.