Understanding Your Insurance

Welcome back everyone! This week we’re talking about the biggest seasonal news out there. Nope – not Christmas. It’s Open Enrollment. That’s right – in addition to turkey and mistletoe this time of year is a very special one for people looking at new health insurance options. So today, we’re adding to our ongoing blog series: “Understanding Your Insurance.” And I’d like to share a little wisdom and help you get the best value for your insurance dollars.

Tips for understanding your insurance:

The #1 Rule is to make sure you understand exactly what your insurance actually covers.

This will help you get value for money in your current policy and help you pick the best policy for next year.

Tip #2 is to maximize value once you’ve met your deductible.

If you’ve met your deductible, the remainder of 2015 is an ideal time for elective procedures, surgeries, appointments, etc. that your current insurance covers. That is why this time of year is exceptionally busy period for healthcare providers. Also, don’t forget that your “well visit” is fully covered by Medicare (with no out-of-pocket expenses) and most other insurance, so make sure to take advantage of this once-a-year opportunity by calling your healthcare provider immediately.

And our blog today wouldn’t be complete without some useful insurance selection tips.

While it’s always nice to get a head start in October to compare your current coverage with other options, but there’s still time to do some research. Think of insurance as a bit of a gamble for you and your insurance provider. You’re paying a set amount up front,  betting that your plan that will provide all the coverage you need & save you money;  but the insurance company is betting that you will need less coverage than you’re paying for. Sometimes you use less, sometimes more – if you’ve got the right insurance this should balance out over time.

So what is the right insurance for you?

It depends on your health needs and your financial situation. Most of you will probably be on Medicare so you need to decide what additional coverage you may want. To do this, its important to understand what Medicare does and does not cover. If you need certain services that aren’t 100% covered under Medicare Part A or Part B, you’ll most likely have to pay for part of them yourself unless you are enrolled in a:

  • Medi-gap (secondary) plan
  • Medicare Advantage plan OR a
  • Medicare Part D Prescription Drug Plan

Keep in mind that:

  • Even if Medicare Part A or Part B covers a service or item, you generally have to pay deductibles, coinsurance, and copayments. In general Medicare covers 80% of the expense of a covered service – so you still have to pay the other 20% which can really add up!
  • Since Medicare Advantage plans do not necessarily provide coverage equal to Medicare, they may not be right for you if you require a surgery or procedure or have a condition (diabetes, urinary incontinence, etc.) that requires ongoing therapy, treatment with a prescription or supplies. Before choosing any Advantage plan be sure to read all the exclusions in your contract. Don’t be blinded by advertisements offering $0 co-pays. If it sounds too good to be true – it probably is!

Now for you Men’s Liberty clients out there – how can you tell what insurance coverage will be provided for your incontinence supplies?

The good news is the traditional Medicare Part B covers services or supplies for diagnosing or treating medical conditions. The one-a-day gold standard in treating male urinary incontinence, Men’s Liberty external collection device, is covered. Just like with other services, Medicare covers 80% of the cost. And if you have a secondary policy that usually picks up the other 20%. That’s 100% coverage right there!

So take action now during open enrollment. Follow these simple guidelines for understanding your insurance to get the most out of your insurance coverage!