• How to Maximize Your Insurance Benefits


    It’s fall so that means it is open enrollment for a lot of people. In addition, since it is the end of the year some people have met their annual deductible and want to take full advantage of the benefits offered in their insurance plan. Today’s blog goes over the terms commonly found in insurance descriptions.

    What is a deductible?

    A deductible is an amount of money that you yourself are responsible for paying for covered medical services before the insurance plan begins to pay for services. The deductible is generally a dollar amount, and can vary by plan. Once the deductible is met your insurance will start to pay a portion of the cost for services. Most plans run on a calendar year, but can vary by plan as well. With the year or insurance plan year coming to an end it is likely that your deductible has been met and that the plan will start to cover a percentage of services. For example: if your insurance plan has a deductible of $500, once that amount if met services such as surgery, physical therapy or imaging will be covered at a variable amount. 

    Difference between you annual deductible and out of pocket maximum

    It's important to remember that reaching your annual deductible often doesn't mean that is the end of your out-of-pocket expenses. The out-of-pocket maximum is just as it sounds. It is the max amount you will pay out of pocket for services that year. Deductible claims go toward the out-of-pocket max along with co-pays and coinsurance amounts paid by you during that year. Once this amount is met it is often the insurance will pick up expenses at no cost to you and many services will be covered at 100% insurance liability.  

    Here’s an example.** You have a plan with a $3,000 annual deductible and 20% coinsurance with a $7,000 out-of-pocket maximum. You haven’t had any medical expenses all year, but then you need surgery and a few days in the hospital. That hospital bill might be $150,000.

    You will pay the $3,000 of your hospital bill as your deductible responsibility. Then, your coinsurance kicks in. The health plan pays 80% of your covered medical expenses. You'll be responsible for payment of 20% of those expenses until the remaining $4,000 of your annual $7,000 out-of-pocket maximum is met. The plan would then cover 100% of your remaining eligible medical expenses for that calendar year.

    How do I know how much of my annual deductible or out-of-pocket maximum is met?

    With many insurance plans having patient portals this makes checking the amounts fairly easy and accessible. You can keep track of these amounts by checking EOBs and payments online through the portal, or by calling the member customer service number provided by the plan. 

    It is important to keep track of these amounts, so you can get the care and treatment you need and hoped to have for the year. 

    How to maximize your benefits

    Once you have met your deductible it is a great idea to read through your plan to see what services are covered. For a lot of plans acupuncture, chiropractic and of course physical therapy are all covered services. So if you have a small complaint you have been ignoring now may be the best time to have a professional provide treatment. Have a stiff shoulder from your high school playing days that gives you occasional grief? Now is a great time to get treatment before January rolls around and the deductible will refresh. 

    Stay Healthy, Stay Safe, Stay Bodywise!