crisp dollar bill in front of white brick wall

Understanding Your Out of Pocket Expenses 101

There’s no doubt that the world of health insurance is challenging. Whether you’re researching new coverage or trying to understand your current coverage, you may feel overwhelmed with the laundry list of options, features, and expenses. It’s likely that you depend on your agent’s guidance and expertise to help you select the coverage that fits your health realities and your lifestyle.

It’s a good idea to have an agent you can trust, but it’s also a good idea to have an understanding of out of pocket expenses before choosing an agent. This will help you understand how a policy will impact your wallet and help you identify which questions to ask your agent before making a final decision.

Let’s take a look at some of these expenses and consider how those they relate to two popular coverage options: short-term medical and health benefit insurance plans.

Deductible

This refers to the amount you pay for yourself before your insurance carrier pays benefits.

If you’re concerned about the cost of deductibles when facing common illnesses such as a cold, an ear infection, pink eye, or strep throat, you may be interested in coverage that includes a telemedicine as a feature.

Telemedicine meets you where you are by allowing you to connect with doctors via phone, video, smartphone, or computer and reducing travel time, anxiety, and time away from family and responsibilities. This feature is available with many short-term medical and health benefit insurance plans as well as traditional healthcare coverage plans.

Copay

This refers to the amount you pay to your providers at the time of service. The amount may vary depending on the type of service you receive and typically does not count toward your deductible.

Affordability is undoubtedly one of your primary concerns when choosing healthcare coverage. Many short-term medical plans offer low out of pocket copays for doctor’s office visits and wellness care. However, the benefits may be more restricted as well since these plans do not need to meet the 10 essential health benefits. They also do not cover preexisting conditions.

If you need another type of coverage and/or if you are considering supplementing your major medical coverage, you may benefit from health benefit insurance, as this type of policy may be cost effective and provides cash benefits to pay for a variety of expenses, including copays. Keep in mind that there may be limitations and/or restrictions, so be sure to fully review the circumstances under which payment can be received.

Coinsurance

This refers to the amount you pay to your provider for services rendered after you pay your deductible and after your carrier covers its portion. This amount is a form of cost sharing and is in addition to the copay that is paid at the time of the visit.

Short-term medical plans offer a variety of coinsurance options, including a 100%/0% option. This can allow you to circumvent a coinsurance payment and would task your carrier with paying 100% of the fees. Keep in mind that short term insurance plans do not cover preexisting conditions and are not required to cover 10 essential health benefits, including maternity and newborn care, mental health and substance abuse disorder services. Check any plan details carefully to understand what is covered.

Health benefit insurance plans do not offer coinsurance options, as they provide fixed cash benefits for specific covered expenses.

 

Note: It is important to keep in mind, that while short-term and health benefit insurance coverage can provide valuable benefits benefits, neither one is intended to be a replacement nor an alternative to ACA or other major medical plans. These types of coverage do not provide the minimum essential health benefits that are required and will not help to avoid the fee for not carrying health insurance.

 

With our leading edge tools and technologies, we’re upgrading how you experience your choice of coverage.

Stay tuned to our next blog post!

Click here to join our Facebook community for more information about your health and your healthcare coverage.

woman who is stressed holding her head

Carve Out Time to Relax this National Stress Awareness Month

Few things in life are certain. Stress is one of those certainties, a detail you are reminded of each day as you manage responsibilities and face challenges. Chances are that you are keenly aware how important it is to hit the refresh button when it comes to your ability to face those matters. April is National Stress Awareness Month, the perfect time to use that button more liberally and to recognize how stress can impact your overall health.

It’s crucial to be able to recognize stress symptoms so you can manage it1. Stress is a natural reaction and is a way to protect yourself from danger. According to the Centers for Disease Control and Prevention2, it can prompt you to develop skills needed to manage potentially threatening situations. But it’s best to be aware of stress and find ways to manage it through self-care.

Some of the common effects of stress are1:

  • Headache
  • Muscle tension or pain
  • Chest pain
  • Fatigue
  • Sleep problems
  • Anxiety
  • Restlessness
  • Lack of motivation or focus
  • Feeling overwhelmed
  • Irritability or anger
  • Sadness or depression
  • Overeating or undereating
  • Angry outbursts
  • Social withdrawal

It’s when our fight or flight response is left unchecked that it can contribute to a variety of health problems such as high blood pressure, heart disease, obesity, and diabetes1.

Consider managing your stress by3:

  • Recognizing when you don’t have control and letting it go
  • Avoiding anxiety about situations you can’t change
  • Focusing your mind on something that makes you feel calm and in control
  • Developing a vision for healthy living, wellness, and personal growth
  • Setting realistic goals to help you realize your vision

Carving out even just a few moments each day to relax can help you manage your stress.

Here are a few ideas you want to explore1:

  • Engaging in regular physical activity
  • Partaking in relaxation techniques, such as deep breathing, yoga, or getting a massage
  • Socializing with family and friends
  • Setting aside time for hobbies, such as reading a book or listening to music

Let’s take a look at a few insurance benefits available to you with short-term medical and health benefit insurance coverage that may help you as you manage your stress:

Wellness care

When you begin thinking about improving your stress management techniques, you’re likely to also begin thinking about how to make healthier choices going forward. Short-term medical and health benefit insurance coverage are options that may be able to help you maintain access to quality healthcare all while including wellness care benefits. While they’re not intended to replace major medical insurance, they can be used to continue access to health benefits.

Preventive care 

Beyond learning more about healthier choices, you may also be interested in learning more about your general health as well as screenings and shots. If traditional insurance coverage is not an option, short-term medical and health benefit insurance coverage can include preventive benefits that give you access to quality physicians who can provide such care.

Routine doctor visits

Maintaining your general health is likely to become a priority as you become more aware of your stress and management exercises that work for you. With short-term medical coverage, you can take advantage of benefits that allow for access to physicians who can provide routine care and consultations. With health benefit insurance coverage, you can take advantage of cash benefits that subsidize the costs of such visits. Both types of coverage can provide access to a network of providers and facilities. It’s important to review any plans carefully to understand what is covered, if preexisting conditions are included or not, and what services will qualify for any cash benefits. While major medical insurance will provide access to routine care, you may find yourself in a situation where you cannot obtain coverage, and these plans may provide an alternative to help you stay on track with your wellness and health goals.

 

Note: It is important to keep in mind, that while short-term and health benefit insurance coverage do provide these benefits, neither one is intended to be a replacement nor an alternative to ACA or other major medical plans. These types of coverage do not provide the minimum essential health benefits that are required and will not help to avoid the fee for not carrying health insurance.

 

 

With our leading edge tools and technologies, we’re upgrading how you experience your choice of coverage.

Stay tuned to our next blog post!

Click here to join our Facebook community for more information about your health and your healthcare coverage.

 

Sources:

1: “Healthy Lifestyle: Stress Management.” Mayo Clinic. https://www.mayoclinic.org/healthy-lifestyle/stress-management/in-depth/stress-symptoms/art-20050987

2: “Coping With Stress.” Centers for Disease Control and Prevention. https://www.cdc.gov/features/copingwithstress/index.html

3: “Take Time to Unwind.” Federal Occupational Health. https://foh.psc.gov/calendar/stress.html