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I hear it almost daily..."I'm healthy - what
do I need health insurance for??"
The
average person lands in the hospital every seven
years. Almost 50% of bankruptcies in the
U.S. are the result of a sudden medical condition
or accident...and believe me...they were all
probably "healthy".
There
is a double-edged sword in today's medical world.
Improvement in medical technology and capability
is unprecedented with even further developments
around the corner through new genetic
advancements. All this is great but as the
capabilities increase so do the resulting costs.
The possibility for the large medical bill is
really why you need health insurance and this
should be ultimately what your plan protects
against.
Maximum
out of Pocket
Most
plans handle this Big What-if with a "maximum
out-of-pocket", quite possibly the most
important part of your medical plan.
It
basically means, if you have a big bill (or a
series of bills) when does the plan pay at 100%.
Of course, this maximum applies to in-network (see
Section 1 Doctor doctor) and for covered benefits.
It usually applies to a calendar year, from
January to December after which it is reset.
Typically, the Maximum includes deductible (we'll
talk about the deductible in the next section -
small bills).
For
a simple example...
You
have a $2,250 deductible and then a 10%
co-insurance up to another $500 maximum. The
unforeseen "what-if", a car accident
occurs with $80,000 of covered, in-network medical
bills. After you have paid $2,750
(your $2,250 deductible and $500 max), then the
insurance carrier will pick up the rest of the
bills according to your covered benefits.
An
interesting fact...
Sometimes
plans have great benefits for smaller bills but
the "back-end", meaning the big bill is
not as good. What good is a $45 doctor
office visit copay if you have to pay $5,500 for a
big bill?!? Remember, this
"back-end" is really why you are buying
health insurance. If you are getting better
benefits for the small bills...guess what...you
are probably paying for it in your monthly
premiums. That being said, let's look at how
the plans handle the small bills.
Pennies
on the nickel?? Understanding how plans
treat the smaller bills from doctor visits to
minor surgery...
Next
Page - Small bills
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