How does a .10-cent aspirin turn into a $20 pill? It can be frustrating and infuriating to decipher a medical bill. Are we getting used to the lack of transparency in healthcare or are we becoming more aware and expecting the hidden costs? Some of the factors in the lack of transparency in healthcare, include the complexity of the healthcare system, the absence of standardization among healthcare providers, and the decentralization of decision-making. Additionally, there are financial incentives that may lead providers to prioritize profits over patient care such as what led to the opioid epidemic, and privacy and security concerns that impede data sharing. Whether it be stress over figuring out if you have enough money to cover your medical care or the frustration that comes with feeling left in the dark, the lack of transparency regarding the healthcare industry has a deep impact on our society.
Everyone needs to be aware of the hidden costs and fees associated with their healthcare plan, especially now as rates rise and benefits decrease. There are many scenarios that may have you questioning what you actually enrolled in. Is it your first time setting up health coverage?
Have you been given limited options through work? If you are an entrepreneur or freelancer exploring your health coverage options as a self-employed professional? Lastly, If you’ve been surprised by unexpected costs in healthcare in the past and are looking for a change.
This is the amount of money you will pay out of pocket before your health insurance begins to pay the claim. Typically, with health insurance the lower your monthly premium, the higher your deductible.
These are the costs you have to pay each time you visit the doctor, get a prescription filled, or receive medical attention. If you have a $30 copay for doctor visits or $500 for emergency room visits, you must pay that at the time of your visit.
This is the percentage of the medical bill you are responsible for after your deductible has been met. Example: If you have 50% co-insurance in your plan for surgery, you will be responsible to pay your deductible plus 50%, and your plan will pay the other 50% of the covered costs.
This is the maximum amount you are responsible for in a given year, even if your medical bills exceed this amount. For example, if you have a $4000 deductible and an out-of-pocket max of $10,000, you will reach your deductible and may be responsible for costs that are not in-network or are not covered by your plan up to $10,000. This amount will start over again in the next calendar year.
Many health insurance plans require you to pay for your prescription drugs out-of-pocket, often including a co-payment or co-insurance. This can range from $0 for some common generic medications to well over $1000 per month for drugs such as immunosuppressants. What kind of medicines are covered and how much it will cost you out of pocket varies widely not only from health plan to health plan but by geographic region and even pharmacy.
This is the money you pay each month to maintain your health insurance coverage.
When comparing health insurance alternatives, it’s good to start with a list of features that you want in your healthcare.
Make a list of what you’re looking for and prioritize it.
High-deductible health plans (HDHS) are designed for people who don't need a lot of medical care. They generally only cover preventative services before the deductible, such as yearly wellness visits. You may have a lower monthly premium with an HDHS, but the deductible will be much higher for any non-preventative healthcare costs. Many people with an HDHS use the money collected in their HSA to pay for some of their healthcare deductibles.
Health Savings Accounts (HSA) allow you to save pre-tax dollars to pay for qualified medical expenses. These can be used on medical bills, prescriptions, and some over-the-counter healthcare needs and deductibles. You may contribute to an HSA only if you have a High Deductible Health Plan (HDHP). Essentially it’s a savings account for healthcare needs.
Catastrophic health insurance provides a safety net for major medical expenses. They have low monthly premiums but very high deductibles. They are meant for worst-case scenarios, such as a serious injury or illness in a typically healthy individual. All routine medical care is out-of-pocket.
Short-term health insurance plans provide coverage for a limited time. A good example would be COBRA. Typically, coverage is usually 3-12 months. Short-term health insurance is meant to be used temporarily during a gap in other health coverage, such as a loss of a job.
Medical sharing plans, also called healthshares, are a form of cost-sharing between individuals that are members. Members pay into a community pool of money and when a member has a healthcare cost arise, money is used from the pool to cover the expense. The healthshares that are offered by indipop are curated with strict criteria offering high value and affordability without sacrificing the quality of care or benefits. These plans are not restricted by religious faith or type of employment.
Direct primary care models are based on a monthly fee for access to a primary care provider, eliminating the need for insurance. indipop offers direct primary care as part of our healthshares so that people will always know exactly what they’re paying to visit their doctors.
While choosing a healthcare plan is a deeply personal decision, it’s always important to know all options available. indipop offers set transparent pricing with plans you can use across the country. You will always know what you’re paying for and how much it will cost when choosing a plan through indipop!