It’s no secret that the American healthcare system has issues.
With over 63% of Americans disapproving of how health insurance currently works. But beyond the general frustration, how can you tell what your insurance covers and if you’re getting what you’re paying for?
The confusing language in healthcare insurance policies and a lack of education on what is and isn’t included means many Americans don’t know what their health insurance covers. While all health insurance plans are different and you should read your plan thoroughly, there are some basic costs most patients must pay:
A copay is a small fee you pay for certain healthcare services while your insurance pays the rest of the cost. This usually covers general doctor visits, emergency room visits, and prescription drugs, though you should check your specific plan to see what it covers. You can get a cheaper plan without a copay but you’ll pay more out-of-pocket.
For services not covered by a copay, you have a deductible. You must pay all services up to the amount of the deductible and copays don’t count towards it. Once you reach your deductible amount, your insurer will help you cover the rest. Check your plan to see what your deductible is.
Once you reach your deductible, you’ll pay a certain amount for healthcare costs and your insurance will pay the rest. For example, you might pay 20% and your insurance pays 80%.
To calculate your maximum healthcare costs, add up your copay, deductible, and coinsurance.
If you’re looking to save money, it’s also best to look for in-network providers. In-network providers have agreed to accept a lower payment rate from your insurance company while out-of-network providers have not made a similar agreement and might cost more.
To learn more about your specific plan, look at the Explanation of Benefits document your healthcare provider will send you. You can also reach out to a specific doctor’s office for clarification on what your plan does and does not cover at their office.
A study conducted by Deloitte found that healthcare providers cover less each year and patients are paying over 672 billion out-of-pocket each year. When planning for 2022, you might consider budgeting more or adding more to your emergency fund in the case of unforeseen health expenses.
If you don’t get healthcare through your work, it can be even more important to budget for healthcare as independent or government-funded healthcare doesn’t cover as much as work-sponsored healthcare.
Curious to see what your healthcare covers at Thrive Carolinas? Give us a call 704-390-7150