by admin | Dec 20, 2023 | Health Insurance
Protection from high medical costs
Health insurance provides important financial protection in case you have a serious accident or sickness. People without health coverage are exposed to these costs. This can sometimes lead people without coverage into deep debt or even into bankruptcy.
It’s easy to underestimate how much medical care can cost:
- Fixing a broken leg can cost up to $7,500
- The average cost of a 3-day hospital stay is around $30,000
- Comprehensive cancer care can cost hundreds of thousands of dollars
Having health coverage can help protect you from high, unexpected costs like these.
When you have coverage, your plan protects you from high medical expenses 2 ways:
- Reduced costs after you meet your deductible Once your spending for covered services reaches your plan’s deductible, the plan covers part of your medical expenses.
- Example: If your plan has a $1,000 deductible, you pay the first $1,000 in covered services. After that, your plan pays between 60% and 90% of your covered expenses, depending of what kind of plan you have. You pay between 10% and 40% of the costs as coinsurance or copayments.
- Out-of-pocket maximum This is the total amount you’ll have to pay no matter how much covered care you get in a plan year.
- Example: If your plan has a $3,000 out-of-pocket maximum, once you pay $3,000 in deductibles, coinsurance, and copayments the plan pays for any covered care for the rest of the year. This provides important peace of mind and protection from very high medical costs.
Pay less even before you meet your deductible
Even before you meet your deductible, you may save hundreds of dollars in medical costs.
How you save money before you meet your deductible
Insurance companies negotiate discounts with health care providers, and as a plan member you’ll pay that discounted rate. People without insurance pay, on average, twice as much for care. This means when you use a network provider you pay less for the same services than someone who doesn’t have coverage – even before you meet your deductible.
- Sometimes these savings are small. If you’re insured and use a network provider, you may pay $25 for a flu shot instead of the $40 someone without coverage pays.
- In other cases the savings can be big. If use a network provider, you may pay $85 for an office visit instead of the $150 someone without coverage pays. Savings can be even higher for more expensive services.
So even if you don’t reach your deductible during the year, you can save a lot of money on your covered medical services just by being enrolled in an insurance plan.
by admin | Nov 29, 2023 | Employee Benefits, Health Insurance
If you have a health plan through a job, you can use a Flexible Spending Account (FSA) to pay for health care costs, like deductibles, copayments, coinsurance, and some drugs. They can lower your taxes.
How Flexible Spending Accounts work
A Flexible Spending Account (FSA, also called a “flexible spending arrangement”) is a special account you put money into that you use to pay for certain out-of-pocket health care costs.
You don’t pay taxes on this money. This means you’ll save an amount equal to the taxes you would have paid on the money you set aside.
Employers may make contributions to your FSA, but they aren’t required to.
With an FSA, you submit a claim to the FSA (through your employer) with proof of the medical expense and a statement that it hasn’t been covered by your plan. Then, you’ll get reimbursed for your costs. Ask your employer about how to use your specific FSA.
To learn more about FSAs:
Facts about Flexible Spending Accounts (FSA)
- They are limited to $3,050 per year per employer. If you’re married, your spouse can put up to $3,050 in an FSA with their employer too.
- You can use funds in your FSA to pay for certain medical and dental expenses for you, your spouse if you’re married, and your dependents.
- You can spend FSA funds to pay deductibles and copayments, but not for insurance premiums.
- You can spend FSA funds on prescription medications, as well as over-the-counter medicines with a doctor’s prescription. Reimbursements for insulin are allowed without a prescription.
- FSAs may also be used to cover costs of medical equipment like crutches, supplies like bandages, and diagnostic devices like blood sugar test kits.
- Get a list of generally permitted medical and dental expenses from the IRS.
- You can’t use a Flexible Spending Account with a Marketplace plan.
FSA limits, grace periods, and carry-overs
You generally must use the money in an FSA within the plan year. But your employer may offer one of 2 options:
- It can provide a “grace period” of up to 2 ½ extra months to use the money in your FSA.
- It can allow you to carry over up to $610 per year to use in the following year.
Your employer doesn’t have to offer these options. If it does, it can be either one of these options, but not both.
Plan ahead At the end of the year or grace period, you lose any money left over in your FSA. Don’t put more money in your FSA than you think you’ll spend within a year on things like copayments, coinsurance, drugs, and other allowed health care costs.
Originally posted on Healthcare.gov
by admin | Nov 14, 2023 | Health Insurance
Accidents happen. Whether you fall off a ladder, slip and break an arm, or get injured just living everyday life, an accident can happen. Anytime. Anywhere.
What Is Accident Insurance?
Accident insurance helps provide support when life’s most unexpected moments happen. It makes an accident less painful financially because it helps to pay the bills that your medical insurance doesn’t completely cover. It is important to understand that accident insurance is not intended to be a substitute for medical coverage. Instead, it is used as additional coverage and financial assistance.
Accident insurance may be offered by your employer as a voluntary benefit. Medical insurance doesn’t cover all of the expenses that result from an injury – you will likely owe a deductible and co-pays – and accident insurance helps fill in the gaps.
Examples of What Accident Insurance Covers:
- Emergency treatment and medical exams
- Hospital stays and surgical care
- Diagnostic tests such as X-rays and CAT scans
- Physical therapy and rehabilitation
- Family lodging and travel needs related to follow-up care
Examples of What Accident Insurance Does Not Cover:
- Injury due to extreme sports like bungee jumping or skydiving
- Self-inflicted wounds or suicide attempts
- Injury that occurs while doing criminal activities
- Injury that occurs while under the influence of drugs or alcohol
How Does Accident Insurance Work?
You pay a premium every month for coverage which is often automatically paid through payroll deductions. If you get injured, you submit a claim as well as any required verification for the accident. Then, once approved, the insurance payment will be sent directly to you – often in a one-time lump sum. Some plans pay out according to your expenses up to a maximum specified in the policy while others pay out a predetermined amount based on the injury.
One of the biggest advantages of accident insurance is that the payouts come in cash, which can relieve the financial burden after an injury. Additionally, there isn’t a waiting period, so you get the money immediately. This money is given to you in addition to what your health insurance pays. When you receive your payout, you can use the money to pay for any of your expenses – rent or mortgage payment, groceries, childcare, medical expenses, or other needs. How you use the payment after your injury is up to you as you recover.
No one wants to think accidents can happen, but they do. So, while life may dose out the accidents, remember there is insurance that can help.
by admin | Oct 25, 2023 | Employee Benefits, Health Insurance
Not understanding benefits terminology is near the top of the list of ways that open enrollment and benefits selection can stress you out. Open enrollment is coming quickly and soon you will be talking about benefit options. The world of benefits and insurance can be confusing. In-network, out-of-network, deductibles, co-pays and co-insurance? What?
Let us help break it down:
Premium – a monthly payment you make to your health insurance provider- it is the cost of having health insurance coverage. It’s perhaps the easiest component of a health plan – it’s the equivalent of a sticker price.
Here’s how it works: Coverage itself varies considerably from one health plan to another but in general, the less you pay for your coverage, the more you’re likely to have to pay when you need health care – and vice versa.
Co-insurance – A percentage of a health care cost—such as 20 percent—that the covered employee pays after meeting the deductible.
How it works: Let’s say you’ve paid $1,500 in health care costs and met your deductible. When you go to the doctor, instead of paying all costs, you and your plan share the cost. For example, your plan may pay 80% so then your share would be the remaining 20%.
Co-payment – The fixed dollar amount—such as $25 for each doctor visit—that the covered employee pays for medical services or prescriptions.
How it works: After your co-pay, your insurance picks up the rest of the bill for that visit. Co-pays typically count toward your annual out-of-pocket maximum (but there can be exceptions depending on your plan). The amount can vary depending on where you go for care, the type of doctor you see, and the type of prescription you are taking.
Deductible – How much you pay before your health insurance coverage kicks in. Your deductible resets every year.
How it works: If your plan’s deductible is $1,500, you’ll pay 100% of health care expenses until the bills total $1,500. After that, you share the cost with your plan by paying co-insurance.
Network – “In-network” refers to doctors and other health providers that are part of the insurer’s preferred network. Insurers sign contracts and negotiate prices with these in-network providers. This isn’t the case for “out-of-network” providers.
Here’s why that matters: Expenses you incur for services provided by out-of-network professionals may not be covered or may only be partially covered by your insurance; you will generally have a higher deductible and out-of-pocket limit when you see an out-of-network provider.
Out-of-pocket Maximum (OOPM) – the absolute most you pay in one year for your health care expenses before your insurance covers 100% of the bill.
Here’s how it works: What you pay toward your plan’s deductible, co-insurance and co-pays are all applied to your out-of-pocket max. If your plan covers more than one person, you will likely have a family out-of-pocket max and an individual out-of-pocket max. That means:
- When the deductible, co-insurance and co-pays for one person reach the individual maximum, your plan then pays 100% of the expenses for that person.
- When what you’ve paid toward individual maximums adds up to your family’s out-of-pocket max, your plan will pay 100% of the expenses for everyone on the plan.
Picking health insurance can be a dizzying adventure and making a mistake can be costly since you are generally locked into your health insurance for one year, with very limited exceptions. But when you understand how open enrollment works and how it impacts your family’s household budget, you can make wise, informed choices.
by admin | Aug 15, 2023 | Health Insurance
Health insurance may not be the most exciting thing to shop for but it’s one of the most important things that you can buy for yourself and for your family. Having health insurance has many benefits. It protects you and your family from financial loss in the same way that home or car insurance does. Even if you are in good health, you never know when you might have an accident or get sick.
Here are some key advantages of having health insurance:
- Access to Medical Care: Health insurance provides you with access to a network of healthcare providers, hospitals, and specialists. It ensures that you can receive timely medical attention when needed, promoting early diagnosis and treatment.
- Financial Protection: One of the most significant benefits of health insurance is the financial protection it provides. Medical expenses can be substantial, especially in the case of major illnesses, surgeries, or emergencies. Health insurance helps mitigate these costs, preventing individuals from facing overwhelming medical bills and potential debt.
- Preventive Care: Health insurance plans cover preventive services at no cost if you use an in-network provider. This includes routine check-ups, vaccinations, screenings, and counseling services.
- Coverage for Essential Health Services: Health insurance plans typically cover essential health services, such as hospitalization, emergency care, prescription drugs, maternity care, mental health services, and rehabilitation.
- Health and Wellness Programs: Some health insurance plans offer additional benefits such as wellness programs, gym memberships, and access to health management tools. These initiatives encourage you to adopt a healthier lifestyle, manage chronic conditions, and take proactive steps towards improving your overall well-being.
- Specialist Care and Treatment: Health insurance often covers specialized medical care, including consultations with specialists, diagnostic tests, and treatments. Having access to specialists can be crucial for managing complex or chronic conditions effectively.
- Family Coverage: Health insurance plans often provide coverage for family members, including spouses and dependent children.
- Peace of Mind: Knowing that you have health insurance can bring peace of mind, reducing stress and anxiety about potential medical expenses. It allows you to focus on your health and recovery without the added burden of worrying about the financial implications.
Your health is your most valued asset. With a good health insurance plan, you help protect the health and financial future of yourself and your family for a lifetime. It’s important to note that the specific benefits and coverage may vary depending on the health insurance plan, provider, and local regulations. Make sure to review and understand the terms and conditions of a health insurance policy before enrolling.
by admin | May 16, 2023 | Health Insurance, Hot Topics
Healthcare costs, and consequently employee health benefit costs, have been growing at an alarming rate in recent years. The U.S. as a nation spends more on health care than any other developed country but has worse health outcomes. How is this possible?
Four Key Factors Driving U.S. Healthcare Costs:
Healthcare gets more expensive when the population expands, as people get older and live longer. The Baby Boomers, one of America’s largest adult generations, is approaching retirement age. Because of this, the 65+ population is growing at an unprecedented rate. According to the U.S. Census Bureau, 21% of the entire population will be age 65 or older by 2030. Older Americans will make up almost one-quarter of the population by 2060.
This growth is likely to contribute to rising healthcare costs in two important ways:
- Growth in Medicare enrollment
- More complex, chronic conditions
- U.S. Population Is Growing More Unhealthy
According to the Center for Disease Control and Prevention (CDC), 6 out of every 10 adults in the U.S. have at least one chronic disease, such as asthma, heart disease, high blood pressure, or diabetes, which all drive up health insurance costs. In 2020, the health care costs of people with at least one chronic condition were responsible for 86% of health care spending.
Additionally, recent data finds that nearly 20% of children and 40% of adults over 20 in the U.S. are either overweight or obese, which can lead to chronic diseases and inflated healthcare spending.
On average, Americans shell out almost twice as much for pharmaceutical drugs as citizens of other industrialized countries pay. Moreover, prescription drug spending in the U.S. will grow by 6.1% each year through 2027, according to the Centers for Medicare and Medicaid Services (CMS) estimates.
Drug pricing strategies also contribute to rising healthcare costs. Drug manufacturers establish a list price based on their product’s estimated value, and manufacturers can raise this list price as they see fit. In the United States, there are few regulations to prevent manufacturers from inflating drug prices in this way.
Simply put, multiple systems create waste. “Administrative” costs are frequently cited as a cause for excess medical spending. The U.S. spends about 8% of its health care dollar on administrative costs, compared to 1% to 3% in the 10 other countries the JAMA study looked at.
Why is administrative spending so high in the United States? The U.S. operates within a complex, multi-payor system, in which healthcare costs are financed by many different payors. With so many stakeholders involved, healthcare administration becomes a complicated, inefficient process.
These inefficiencies contribute to excess administrative spending. The main component of excess administrative spending is billing and insurance-related (BIR) costs. These are overhead costs related to medical billing, and include services like claims submission, claims reconciliation and payment processing.
Administrative costs, an aging population, rising prescription drug costs, and lifestyle choices all play a factor in ballooning healthcare expenses. While some of these factors are not in your control, others are. Find out where you can make a difference, not only in health insurance costs, but also to your overall health!
