While there is no question that health insurance is my favorite subject, I know that is not the case for everyone! To most, insurance terminology sounds like word soup, and discussing insurance is just about as fun as watching paint dry! But health insurance is a very important aspect of our everyday lives as it protects our most valuable, priceless and somewhat irreplaceable asset – our bodies. Having the right health insurance should be our guarantee that in the event of a medical emergency, we will have access to decent care without draining our bank accounts. Yet, so many are uninsured and those who have benefits are often unaware of what benefits they actually have and how to use them properly.
Insurance offerings vary widely and there’s tons of ways to obtain health coverage. But how does the average person navigate that? And how can they be sure that they are getting the best value? In this short blog, it will be impossible to turn you into an expert, but hopefully it will get you thinking and it will help you ask the important questions whenever you are choosing an option for yourself and your loved ones. My dream is for all of us to become more educated healthcare consumers one day and this is one of my attempts to do that; a small drop in the bucket that will hopefully create some sort of ripple!
Now would probably be a prudent time to insert a disclaimer: The resources and information provided herein are meant to be a guide ONLY and are not actual insurance or coverage, nor are they all-inclusive. Information is subject to change. User assumes all risks & final billing. Please see your policy documents for details & coverage. Exclusions and/or limitations may apply. May not be available in all states
There, I think we got it all! Since that is out of the way, let’s begin! While we know that all people were created equally, let’s be honest, all insurance is not! And, suffice it to say, the strength of your benefits has a direct correlation to the cost of your benefits. In other words, you get what you pay for! That’s not to say that amazingly affordable solutions do not exist, because they absolutely do! It is just to say that if it sounds too good to be true, buyer beware, it probably is!
How different health coverages stack up
Typically, getting coverage through your employer is the most valuable solution. Most employers are required to contribute a minimum of 50% to the employee’s payment for their insurance policy; not to mention these plans offer pre-existing coverage from day one as well as maternity benefits. But did you know that these seemingly common health needs are not actually common benefits in the world of health benefits?! That’s right, pre-existing coverage and maternity coverage are mostly limited to employer and Marketplace plans depending on the market or state that you are in.
While there are tons of health coverage options teeming the internet, many of them are not able to call themselves major medical. This, unfortunately, is not common knowledge, and many people could be restricting themselves from getting benefits for mental health, substance abuse, maternity and pre-existing conditions by not understanding what type of insurance they are signing up for. Please refer to Exhibit A for a chart of how different types of coverages stack up against one another.
Now, many may not need the types of coverages mentioned in the former paragraph, therefore, they should select a plan that is more tailored to their needs. As you can see, selecting a health insurance plan can and should get very personal. Phrases such as, “What pre-existing conditions need to be covered?” Or, “What medications need to be covered?” should be asked of every client because what good is a plan if it doesn’t work in the way that you need it to?
Balance billing vs Deductible in Health Insurance
Plans also vary in the manner in which they pay claims/benefits. For example, some plans pay 1st dollar benefits and balance bill the insured. A plain example of this is where a plan gives you $50 for a doctor’s visit and if the visit costs $75, you will owe $25. Some plans make the insured pay first, then insurance starts paying only after the insured has satisfied a certain dollar amount, also known as a deductible.
Deductibles affect your premiums and your out of pocket exposure from day one. Many people, however, will choose a high deductible health plan just to save on their monthly costs. The reality is that this could have inadvertent, adverse effects as those who choose a high deductible health plan are more reticent to seek medical treatment because they know they will need to pay out of pocket for all of their medical expenses until they satisfy that high dedcutible.
But remember those amazingly affordable solutions that I referred to earlier? Here is one that you should be aware of. You can pair a primary care subscription service, or Direct Primary Care option (like Meridian Springs Primary Care), with a high deductible health plan to round out your health coverage. This pairing gives you unlimited access to your Primary Care Physician who can take care of most of your general medical needs for a reasonable monthly subscription fee, then you layer that with a low premium, high deductible health plan for a stop-loss in the event of a major accident or critical illness. See! The waters aren’t so treacherous if you know how to navigate them!
This is just one example of the multitude of solutions that are available, but ultimately, the best way to choose the right type of health coverage is to find a trustworthy, licensed professional that you can create a longstanding relationship with. It is no secret that the world of health coverage is an ever-changing, innovating landscape. But it is nothing to be afraid of. Your health is your true wealth and knowing a little leads to knowing a lot.
With Sincerest Regards,