New Year.  New Plan?

As we approach the New Year, we also enter into the season of open enrollment.  Health insurance plans change and deductibles reset during this time. Understanding these changes can be frustrating and confusing without knowledge of health insurance.  Here is what you need to know.

Do You Understand Your Deductible and Co-Insurance?

A deductible is the dollar amount that needs to be met before your health insurance will begin to pay claims. If your deductible for the year is $1000, you must pay up to $1000 before the insurance begins to pay.

Co-insurance is the cost share percentage that puts a certain amount in your responsibility.   If the insurance covers 80% of the bill and the charge is $100, $20 will be your responsibility.

What is a Medicare Advantage Plan?

There can be a great deal of confusion when patients switch to a Medicare Advantage plan.  A Medicare Advantage plan is sponsored by a private insurer (e.g.; Aetna, Blue Cross) that replaces Medicare as your primary insurance.

Medicare Advantage policies often carry lower premiums but are offset by higher out-of-pocket costs. You can expect to pay less in monthly premiums but more when you utilize health care services.

Notification of Health Insurance Changes

Unions and employers often make changes at the beginning of each calendar year.  A few years ago, the state of New Jersey announced changes for public workers and retirees (health benefits changing).  While most employers provide ample notice of a change, often retirees are left to rely on letters mailed home from the insurance carrier.

What Can You Do?

If you feel your insurance has changed or will be changing, it is important to confirm that your current physicians are in-network with your new plan. Some health insurance plans carry out-of-network benefits.  In these cases, benefits are paid at a rate that may have higher out-of-pocket costs than providers in the network.

Most importantly, if your insurance has changed and you have questions or concerns, regarding physical therapy or any aspect of your benefits, we are here to help you.  If you receive a new insurance card in the mail, even if the card looks similar or the same, present it to our front office professionals so they can update your record.

Any questions about your insurance, contact us so we can help.