The why, how and what may be next in the U.S. health insurance expenditures

It is not unusual to hear stories of healthcare costs that play a large part in the rise of personal bankruptcies, or why people don’t have health insurance, simply because they can’t afford it. In fact, this is exactly what President Obama tried to address with the Affordable Care Act known as ACA. The whole logic behind getting maximum number of people in the insurance pool was to provide affordable health insurance to one and all. As more healthy people get covered, there would be an increase in the possibility of reducing the medical bills of a sick person. The most recent Kaiser Family Foundation survey found that most marketplace enrollees like their health insurance coverage, though satisfaction with premiums and deductibles has declined since 2014. However, it is unrealistic to expect a miraculous change in the rising numbers associated with medical services.

Here is the good news about making the right health insurance choice and saving money!

We can complain all day long about how medical bills are creating a hole in our pocket. But that won’t solve anything. TrueCoverage has put together easy tips that can help you manage rising healthcare costs.

Know Your Health Insurance Plan – inside out!

It is important to spend time learning the ins and outs of your insurance account before you need to make major medical decisions. When you get a free quote from an online health insurance marketplace like TrueCoverage, you can clearly view all the health plans suitable for you side-by-side. Every plan is required to provide a standard Summary of Benefits and Coverage, which is usually about eight pages. This is a good place to start your evaluation because everything depends on what your respective health insurance plan covers. Also, remember all Marketplace plans must cover treatment for pre-existing medical conditions.

What are the costs associated with your health insurance plan?

  • Premium: the amount that must be paid to a health insurance company for a health plan. Consumers and/or their employers pay this monthly, quarterly or yearly.
  • Copayment (or copay): is a fixed amount consumers pay for a health care service. The amount varies based on the type of service covered. For example: seeing a doctor will have a lower copayment, than an emergency room visit. Also, recall in-network services will have lower copayments than out-of-network.
  • Deductible: the amount a consumer owes for health care services before the health plan begins to pay. Some health services may be covered prior to meeting the deductible. Premiums and copayments do not count towards the deductible. For example: Deductible of the plan is $1000. The consumer must pay $1000 for services before the company pays for any subsequent service.
  • Coinsurance: is the consumer’s share of the cost for a covered health service, calculated as a percentage of the amount allowed by the health plan for that service. The consumer would pay coinsurance plus any deductible owed. For example: The service allowed amount costs $100, the consumer would pay 20% or $20. The health plan would then be responsible for the remaining $80.

Check whether you are eligible for subsidy or tax credits.

Under the ACA, the main type of individual subsidy is a premium tax credit, which is either paid in advance to the insurer on your behalf, or which you can claim on your federal income tax return. If you or a family member…

  • enrolled in and paid for coverage through the health insurance marketplace for one or more months of the year in which you are not eligible for non-marketplace coverage,
  • are ineligible for Medicare, Medicaid, or similar government program,
  • cannot get affordable coverage through an eligible employer-sponsored plan that provides minimum value as defined by the IRS,
  • do not file a Married Filing Separately tax return (with certain narrow exceptions), and
  • Cannot be claimed as a dependent on someone else’s tax return …you could be in line for a premium tax credit.

The size of your premium tax credit depends on your household income, your household size, and the cost of a benchmark plan in your area. In general, subsidies are available to households making between 100% and 400% of the federal poverty level, or up to $97,000 for a family of four.

Ask about prices for medical services beforehand and about cash discounts.

Keeping your insurance card in your pocket and simply asking to pay in cash might save you hundreds of dollars on procedures like blood tests. This may require calling your insurance company, doctor, and hospital to find out what a procedure or an office visit will cost. Remember that some doctors and facilities will offer a discount if you pay cash.

Choose the right care facility.

The rule of thumb is simple – if your condition isn’t life-threatening, don’t go to the emergency room, because it costs more. Have a good understanding of all the options you have nearby, so that you know exactly where to go when you are ill.

  • Your Doctor: Call your doctor’s office first to get a quick opinion about your medical condition, as they know your history to make quick recommendations.
  • Urgent Care: If your condition isn’t life-threatening but needs to be taken care of right away, then you should look at finding the nearest urgent care center. They are usually open after normal business hours, including evenings and weekends. Many offer on-site diagnostic tests like x-rays and lab services. Also, note that you save time and money by going to urgent care instead of an emergency room.
  • Emergency Room: Visit the emergency room for a life-threatening medical condition like uncontrolled bleeding, chest pain, heart attack, difficulty breathing and possible stroke.

Check your bills, once, twice.. maybe thrice!

Insurers are not error-free when it comes to calculating your bills. Always check both bills and summary of benefits, a statement that condenses which procedures and services are covered and those that remain for you to pay.

Remember Preventive care is Free, so make the most of it.

Thanks to the Affordable Care Act (ACA), all health insurance plans must cover specific preventive care services, including vaccinations, certain disease screenings and also certain types of counseling. These services are free if you get your care from a provider in the network. Here is a complete guide to free preventive care services.

TrueCoverage’s licensed insurance agents are here to help!

We understand that it is not easy to understand ACA health plans, the changing law, and paying high amount of premiums every month or paying a penalty for not having health insurance. That’s exactly where our experienced agents can help. They can help you get the best quotes, explain all the benefits and guide you about subsidy eligibility. All for free. Yes, you read that write. Get a free quote today and let us help you find the right health insurance coverage and save money!

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