I posted this in another topic, but I starting a new thread if anyone is interested. I covered the basics of health insurance in one of my classes today and thought I would bring it up here.
Most "open" enrollment times are in October
and November. If anyone is interested in some ideas on how to get the
most out of your insurance then here it is.
Most employers offer
at least 2 types of insurance. If you are married and both work for an
employer who offers insurance than that could mean 4 or more choices.
Many people choose the insurance that is the cheapest in premiums.
But, it may not be the cheapest overall.
Go to the websites of
the various insurance companies. Have the name of the specific group
plan. Do a physician search to see if all the physicians your family
uses are on each plan. Just because you keep the same insurance does
NOT mean your physician will accept it for the following years. The
insurance company and the physician may not contract with each other.
You may also contact your physician office.
What is your premium
(how much you pay monthly) for this plan? How much is your deductible
(amount you pay for the year BEFORE the insurance company pays) for
this plan?. How much are your co-pays (amount that you pay) for each
visit?
Are there any limits on number of visits for ancillary
services (mental health, physical or massage therapy)? Do you need a
precertification for any procedures or special medications?
Check
the companies drug formulary. Most often you can find this on their
website. Often there are "tiers" of drugs. Tier 1 pay be paid for
completely, tier 2 may have a .00 copay, Tier 3 may have a .00
copay. Check to see if you can order 90 day supply of meds as this is
usually much cheaper.
Check to see if your employer offers a
Medical Saving Account. This allows you to have a certain amount
withheld PRETAX for non reimbursed health care expenses such as
co-pays, supplies and over the counter medications.
If you have
a "high deductible health plan" you may set up a Health Savings
account. That is an account of your own savings that can be used from
health care expenses such as paying the deductible, or co-pays. The
amount you contribute may be used as a tax deduction.
Many
people don't realize that physicians and facility bill your insurance
company as a courtesy to the patient. It is the patients job to find
out what their responsibilities are. Most patients don't realize that
the form they are signing allowing the physician to bill the insurance
company also states that the patient will be responsible for any amount
not paid.
THANKS FOR THE INFORMATION I JUST WANTED TO SAY IT WAS NICE OF YOU TO POST SUCH INFORMATION JUST IN CASE SOME OF US MAY NEED IT.
THANKS AGAIN AND HAVE A WONDERFUL EVENING.
Mary,
I would only add one thing. The difference between a co-pay and a co-insurance. We see a lot of patients that don't realize that this is a different thing.
A Co-Pay - is a set amount that you have to pay per visit. i.e. If your Co-Pay is , then you pay per visit after you meet your deductable.
A Co-Insurance - is a percentage that you have to pay per visit. i.e., your company may have an 80% / 20% benefit, therefore, the company will pay % of your visit and you are responsible for 20%. Again, this happens after you pay your deductable.
When my insurance switched I went from paying a copay to paying 20% of my visit. Now when I see my Rheumy, my cost is . As you can see, it's a big difference.
The Co-Insurance was a great option when we had no illness, but now, it's the pits!
Thank you Debra for pointing that out. You are totally correct. Your RD costs 0 a visit??? For that I hope they're curing you! Maryblooms--Thanks for posting that--very informative.