In the last few years mental illness has steadily become a topic of conversation for many people. We’re seeing people take their mental health more seriously. It’s important to take care of your mental health. In fact, it’s just as important as your physical health. Insurers haven’t always seen it this way, though. In the past, many health insurance companies covered physical health problems greater than mental health problems. However, thanks to the Mental Health Parity Act and the Affordable Care Act, health insurance covers mental health the same way it covers physical health. Below we’ll look at both of these laws and why mental health is so important.
Mental Health Parity Law
The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Act was passed in 2008. The law is more commonly known as the mental health parity law or the federal parity law. It says that insurance companies must treat coverage for mental illness and behavioral health and substance use disorders the same as coverage for medical and surgical care. This includes treating them the same financially. For example, an insurance company can’t charge a $40 copay for an office visit to a mental health professional when they only charge a $20 copay for most medical office visits.
The parity law also covers limits on treatment that are not related to money. For example, it used to be common to put limits on the number of visits to mental health care that could be made in a year. The law has pretty much done away with these annual limits, but it doesn’t stop the insurance company from putting limits in place that have to do with “medical necessity.”
Health Plans Affected By The Mental Health Parity Law
In general, the following types of health insurance are covered by the mental health parity law:
Employer group health coverage for companies with more than 50 employees
Plans bought through a health insurance exchange
Children’s Health Insurance Program (CHIP)
Most Medicaid programs, however requirements can vary from one program to another
Some other plans and programs run by the government are still not covered by the parity law. The federal parity law does not apply to Medicare, but it does apply to Medicaid. Some state employee plans, like those that cover teachers and people who work at state universities, can choose not to follow the parity rules.
Diagnoses Covered By The Mental Health Parity Law
The federal parity law covers all mental health and substance-use disorders that a health plan covers. But a health plan can choose to not cover certain diagnoses, whether they are in the physical/medical realm or the behavioral/mental health realm. This is because the parity law doesn’t require insurers to offer mental health benefits. Instead, it says that if mental health benefits are offered, they can’t have stricter requirements than physical health benefits. Your plan’s description of mental health benefits should tell you about any exceptions.
Mental Health And The Affordable Care Act
The Affordable Care Act (ACA) was passed in 2010, and its goal was to make healthcare more affordable. Plans that follow the ACA guidelines include mental health care as one of the “10 essential health benefits”. This means that if you sign up for an ACA-compliant health plan, your mental health services are covered. The ACA also says that insurance companies have to put a limit on how much customers have to pay out of pocket and that there can’t be limits on how much mental health care is covered annually or for a person’s whole life. These steps make sure that people can get mental health insurance and that it is affordable.
What Mental Health Services Are Covered?
All ACA compliant plans should cover mental health as an essential health benefit. Your plan should cover some or most of the cost of mental health services, just like it would for other medical conditions. All plans under the ACA must cover the following mental illness services:
Outpatient individual or group counseling and therapy
Diagnostic services like psychological testing and evaluation
Ongoing outpatient treatment such as treatment programs and medication management
Outpatient treatment for alcohol or chemical addictions
Detox services
Substance abuse recovery treatment
Inpatient mental healthcare in a psychiatric facility
Why Mental Health Coverage Is So Important
There are many reasons why having health insurance that covers mental health needs is a good idea. Mental health issues can happen to almost anyone at any time, with most of these issues needing treatment. The cost of therapy and medication can quickly add up and get expensive. If you don’t have insurance for mental health, you would end up paying out-of-pocket for your care. It could easily amount to tens of thousands of dollars. On top of being financially beneficial, mental health coverage can also save lives. If you have a mental health condition, it’s hard to put a price on how important treatment is. Let’s look further into the impact mental health has.
Physical Health
Studies show a link between mental health and physical health. Mental illness can cause stress and make our immune systems less effective. Because of this, our bodies may not be able to handle illness as well. When your mind is sick, you might develop anxiety or depression, which can make it difficult if not impossible to stay active. Which can lead to letting your physical health deteriorate and struggle to correct it.
Relationships
One of the most interesting reasons why mental health is so important is that it affects your personal relationships. Mental illness can change the way you talk to your friends and family. People with mental illness are often passive-aggressive, hostile, and unable to join social activities. This can cause problems within your emotional support system. Mental illness can make us want to hurt people we care about for no apparent reason. Taking care of our mental health on our own and, if needed, taking medicine can help us live a mentally stable life and keep our relationships.
Emotional Well-Being
How you feel on the inside every day is just as important as how healthy your body is. Advice about mental health shows how a negative mind can make you feel sad, angry, or uneasy. Taking care of your emotional health can help you be more productive and effective at work and in your daily life. You can get advice about your mental health from friends, family, and a psychologist to keep an eye on your emotional and overall health.
Prevent Suicide
A study by the National Alliance on Mental Health (NAMI) found that 46% of people who kill themselves have a known mental health problem. In another study, the US Department of Health and Human Services found that about 60% of people who killed themselves had a mental illness like major depression, bipolar disorder, or dysthymia. This shows the link between mental health and suicide, as well as how early medical intervention and self-care can help reduce the number of suicide deaths. It is important to follow advice to keep our mental health in good shape and to always be aware of the mental health of those around us If you or someone you care about is in trouble, call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255). This number is toll-free. Anyone can use this service 24 hours a day, 7 days a week.
Prevents Criminal Behaviors
Some studies show that if you have a mental health condition, you are more likely to commit violent crimes. The risk is even higher if you use drugs and alcohol and refuse to get proper treatment. Mental health conditions are often the cause of someone committing crimes against their family or friends.
Financial Stability
One of the many reasons it’s important to take care of your mental health is that it makes you more productive and financially secure. According to research published in the American Journal of Psychiatry, people with serious mental conditions earn 40% less than people without. The World Health Organization also says that depression alone causes nearly 200 million lost workdays every year. It is well known that people with poor mental health are less productive, which hurts their finances. It is important to take care of mental health in the right way if we want good work performance and financial security.
EZ Can Help
Getting help for any signs of mental illness shouldn’t be hard because of how much it costs. We can help if you think you can’t get help because you don’t have enough insurance or can’t afford health insurance. You don’t have to worry about paying for EZ’s help to find an affordable health insurance plan because it is free. We want to make sure that you get the help you need. We’ll give you your own agent, who will compare all the plans available in your area and give you quotes in minutes. We won’t just help you find the best plan, we’ll also sign you up for free. Enter your zip code in the bar below to get free instant quotes, or call 877-670-3557 to talk to a live agent.
The average size of a woman’s breasts in the United States has steadily increased over the past five decades, from a 34B in 1983 to a whopping 34DD in 2023. And that’s just the average; bra sizes go all the way to H. While a larger cup size can be appealing to many, it can also be debilitating.
In many instances, a woman’s breast size can impede her ability to work, exercise, and even care for her family. Multiple seemingly unrelated areas may experience pain as a result of the weight of breasts that are disproportionately large. After years of wearing “industrial style” support bras, ridges form across the upper shoulders, straining the muscles and frequently causing headaches and neck pain. The delicate skin beneath the breasts is susceptible to inflammation and infection. Chronic lower back pain is a common complaint among women who compensate for their posture by shifting their weight.
Health insurance is one of the most unexpected “obstacles” for women interested in breast reduction surgery.Many of these women are well into the process of preparing for surgery, researching surgeons and enduring (often multiple) consultations and examinations, when they discover that their insurance policy does not cover the necessary procedure.
A breast reduction, also known as a reduction mammaplasty, is a surgical procedure that reduces your cup size by removing excess breast tissue, fat, and skin. Due to the negative effects that large breasts can have on their health, many women opt for this surgery. Common health problems that are associated with oversized breasts include:
Neck pain
Back pain
Shoulder pain
Rounded shoulders (kyphosis)
Poor posture
Shoulder grooves from bra straps digging into the skin from inadequate support
Numbness in the chest, arms, or fingers due to nerve compression
Breathing problems, specifically while laying down or sleeping
Skin rashes and infection, typically in the fold beneath breasts
Migraines
The Cost of Breast Reductions
As of 2023, a reduction mammoplasty can cost between $4,822 and $11,442. This includes the fee for a board-certified plastic surgeon, hospital fees, medical and diagnostic testing, surgical and post-op garments, and medications. This doesn’t include the cost of anesthesia as it can vary greatly depending on the amount used. The surgeon’s fee also varies based on their level of experience and expertise, their surgical techniques, and whether they perform the surgery in an outpatient hospital or a surgical center.
Health Insurance Coverage
As long as the breast reduction surgery meets the criteria for medical necessity, the majority of insurers provide full or partial coverage. Breast reduction is usually considered cosmetic by major insurance companies unless your breasts cause symptoms such as numbness and tingling, ulceration, significant pain, or persistent rashes. In order for an insurer to cover the procedure you have to prove that you have attempted to treat these issues with other means, such as medication or physical therapy. If you can demonstrate that the procedure is medically necessary, the insurer may classify it as reconstructive rather than cosmetic and provide coverage. Health insurance will cover breast reduction if:
You have breasts that are large enough to be reduced by at least 3 cup sizes.
The rashes or strap marks cannot be treated properly without the reductions.
Your breast size was unaffected by documented weight loss.
Your head, neck, shoulder, or back pain persists despite regular therapy visits.
The size of your breasts prevents you from exercising and maintaining a healthy body weight.
Like we said above, you have to prove that you have exhausted every other treatment option over a course of 6 to 12 months in an effort to resolve any complications your breast size causes. Your insurance company will only consider covering the breast reduction surgery if you provide documentation of all these health problems and attempted treatments. Even if you are approved you may still have to pay a portion of the surgery, in addition to any deductible or coinsurance associated with the procedure.
Steps To Getting Your Breast Reduction Covered
There are a few steps you may have to go through to make sure your health insurance will cover your breast reduction, including the following:
Meet with your PCP
It’s important to meet with your PCP to discuss all of your symptoms first. A PCP will record your pain, and discuss treatments you can start since most insurance companies will want proof that you tried to treat this without surgery. Don’t forget to include every symptom, even if they seem small like minor aches, or discomfort from your bra. Any and all symptoms recorded will help you later down the line when you’re asking for approval for the surgery.
Understand your benefits
Read through your health insurance benefits of the company’s online resources to learn about your specific level and type of coverage. This will help you find out if you can even get breast reduction surgery covered at all. However, don’t always rely on your own interpretation of your benefits. Reading through will help you gain some understanding about the coverage or what documents you need, but don’t stop there.
Call your insurance company
You can ask your company directly if they will cover the surgery and if pre-approval is necessary for breast reductions. Nextask what kind of documentation you will need to prove medical necessity. You also need to find out if your insurance company will require you to use a plastic surgeon within their network.
Pre-authorization
Even if you have a comprehensive health insurance plan that generally covers breast reductions. You will still need to provide proof that the procedure is medically necessary. Before you can schedule surgery, you must first give your insurance company medical records from licensed physicians showing that you have physical complaints and have attempted less extreme treatments. These documents may require a six to 12 month backdate. The physician notes you may need include your OB/GYN, primary care physician, orthopedic surgeon, and physical therapist, among others.
In addition, the majority of plastic surgeons recommend that you have documentation of any complementary and alternative medicine therapies such as acupuncture or chiropractic care. During your initial consultation for breast reduction, your doctor may take photos of your pro-op breasts for insurance purposes. Additionally, they can provide you with a note detailing the symptoms that prompted you to seek breast reduction. All of this documentation will be reviewed by a panel of medical professionals that work for your insurance company. They will evaluate your medical history and determine if breast reduction surgery is medically necessary for your case.
Initial Rejection
According to AARP, up to 14% of all initial insurance claims are denied. However, this doesn’t mean it’s impossible to get coverage. You have the ability to appeal the denial. You do this by having your surgeon write a letter to the insurance company explaining why you qualify for the surgery. It’s also wise to get letters of support from any other medical professionals to strengthen your case.
Authorization
Once your paperwork has been accepted and your insurance company has given its approval, you can go ahead and schedule your breast reduction surgery. The majority of insurance providers will require you to pay a copay for the hospital or medical facility stay. Which can range from $100-$300.
Is A Breast Reduction Ever Automatically Covered?
You won’t need to document a long history of trying to relieve symptoms if your reconstructive surgery is tied to a mastectomy. Which is a breast cancer surgery that removes the entire breast. It is usually offered to women who can’t or doesn’t want to be treated with breast conserving surgery. Which would save most of the breast while removing the cancer cells. It’s also offered to women who have a high risk of getting second breast cancer. In this case, the patient can choose to get a double mastectomy, which will remove both breasts. Now say prior to having your mastectomy you had all of these health issues because you had large breasts. Once you have the mastectomy you are able to get reconstructive breast surgery and your breasts will be a proportional size to your body, therefore alleviating the medical conditions.
Working With EZ
Having breast reduction surgery can significantly improve your quality of life. So, it’s unquestionably worth investigating, especially since some insurance policies will cover the procedure without much hassle. You could enjoy a more active lifestyle with less pain or discomfort. If you are looking for a company that will cover breast reduction surgery, come to EZ. One of our agents will research and compare all available plans within your budget. EZ understands how difficult this pain can be and we want to make getting health insurance one less headache (or backache) for you. Your personal agent will compare all of the quotes in your area. As well as answer any questions you have for free. To get started enter your zip code into the box below for your free instant quotes. Or call one of our licensed agents directly at 877-670-3557.
So, you’ve decided it’s time to cut ties with your health insurance plan, but can you cancel your policy? The answer is both yes and no. You can cancel your health insurance, but if you do it at the wrong time or without a backup plan ready to go you could face fines or massive coverage gaps.
When To Cancel Your Health Plan
It’s best to cancel your health insurance policy once you have a replacement ready to take its place. If you don’t, you will have coverage gaps, leaving you vulnerable in the event of a health emergency. If you are looking to make the switch,Open Enrollment Period (OEP) is the best time to look into a different health insurance plan. The only time you can switch to a new health insurance plan outside of the OEP is if you qualify for a Special Enrollment Period (SEP). You qualify for an SEP if:
You just got married
Filed for divorce
Just had a baby
You or your spouse got a new job, losing your group health insurance coverage
You’re moving outside of your coverage area
Your current plan is no longer offering coverage in your area
Your current health insurance company is out of business
The Right Way To Cancel Your Private Health Plan
It’s important to cancel your health insurance plan properly so that there is no confusion or loose ends. Below are the steps you can take to cancel your plan the right way.
Call your health insurance company
If you have health insurance through the Marketplace, you can login to your account and terminate the plan’s coverage. If you need help canceling your plan online, you call their customer service line. When you’re canceling a private health insurance plan, you can contact your insurance company directly. Your health insurance company’s phone number is printed right on your policy, health insurance card, and premium bills. Your health insurance provider may let you cancel over the phone. Occasionally, they may request that you fax or mail them additional documentation such as a confirmation letter.
Follow Your Plan’s Cancellation Process
Every health insurance provider has a cancellation procedure you must adhere to, such as ensuring your policy end dates are accurate to avoid a lapse in coverage. During your online or phone cancellation, an insurance agent will confirm the steps you have to take to successfully cancel your health insurance plan. Note the name of the representative and any cancellation confirmation numbers. This is important in the event that there are any procedure errors during the cancellation you’ll be able to quickly prove when the policy was ended.
Ask About Premium Refunds and Check Your Bank
If you paid your plan in full for the year and want to cancel it before it expires, ask your health insurance company if it will reimburse you for the months you’ve already paid for but have not used yet. Many insurers will issue a refund for the remaining time on your policy. Check your bank statements after your new health insurance coverage begins to ensure that the canceled plan is no longer in effect and charging your account. You’ll also want to make sure that the new policy is active and has taken the first payment if you have one.
Check Your Active Health Coverage
Don’t cancel your old policy until you’ve gotten a new one and reviewed the coverage start date. Make sure the active coverage periods don’t overlap, as it’s illegal to submit claims to two separate major medical policies. You’ll also want to check your monthly health allowance if your employer reimburses you for your insurance premium or other out-of-pocket medical expenses through a health reimbursement arrangement (HRA) or health insurance stipend. This amount may affect your desired premium payment and the types of medical expenses you may get. Additionally, check the type of HRA your company offers. Integrated HRAs supplement employer-sponsored health insurance plans by helping to pay for deductibles, copayments, medical services, and other out-of-pocket costs, but cannot reimburse health insurance premiums.
Know Your Rights
Every state has consumer protection laws and insurance regulators who can help you with questions or complaints regarding your individual coverage. Your state laws may address health coverage requirements, prompt payment of claims, access to specific specialists, and certain treatment coverage. These protection laws apply to all plans, whether individual coverage or employer-provided health insurance, in order to safeguard your access to health services. If you submit false information on your health insurance application, your policy could be canceled. However, they cannot terminate your coverage if you made an honest error on your application. If you have unpaid premiums, your provider can terminate your coverage. In the majority of instances, your health insurance provider must give you at least 30 days notice before canceling your coverage due to missed monthly payments. This notice affords you the opportunity to appeal the decision or find a more cost-effective alternative.
How To Cancel Your Group Health Plan
You may need to cancel your employer-sponsored health insurance plan, even if you remain employed with the company. For example, your spouse or domestic partner’s employer may offer a more affordable plan option. Canceling an employer-sponsored plan is fairly easy if you follow these steps:
Contact HR – Your company’s human resources department will be able to answer your questions and will be your primary contact through the entire cancellation process
Ask about dates – Make sure you know the cancellation date, and make sure your new coverage will begin on or right after that date. You don’t want your plans to overlap.
Complete the paperwork – If you’re opting out of your group plan early, there will likely be a bunch of paperwork that comes with it. Make sure you complete, sign, and submit these forms on time
Cancellation Penalties
In most instances, there is no fee for canceling a health insurance policy. However, some insurance providers do charge a cancellation fee. This would be specified in your plan’s terms and conditions, so you are aware of this policy before you buy it. While the federal government no longer imposes a tax penalty for not having health insurance, some states do. The District of Columbia, California, Massachusetts, New Jersey, and Rhode Island have penalties for not having health insurance. Each state has its own system of fees. Check your state’s regulations before you cancel your health insurance, as you may qualify for an exemption from the tax penalties.
When Can’t I Cancel My Health Plan?
There are very few circumstances where you’re not able to cancel a health plan early. Some employer group health plans are paid for out of your paycheck prior to taxes being taken out. These plans are called Section 125 plans. They can be an excellent way to save money on insurance and taxes. If you have one of these plans, however, you can only change or cancel it during the Open Enrollment Period, or if you have a qualifying life event. Your HR department will be able to let you know if that’s the case with your group plan.
Additionally, if you are under 30 and have a short-term or catastrophic insurance plan, you may not be able to cancel your coverage early. Many of these plans are bought for a specific period of time and can’t be canceled early. Make sure you understand the terms and conditions of these plans before enrolling.
Why You Need Health Insurance
So far we’ve talked about how to switch health insurance plans, but we haven’t mentioned people canceling health insurance with no plans to get another plan. We know that sometimes when money is tight you start cutting expenses and health insurance is one of the first things to go. Especially if you’re healthy you think “well, I don’t use it, I don’t need to pay for it”, but that way of thinking can be detrimental. While being healthy is great, the objective here is to maintain that health throughout one’s life. Unfortunately, neither disease nor accidents can be predicted. Without health insurance, you are responsible for all of your medical expenses. Which poses a substantial threat to your financial and medical stability.
Health Benefits Of Health Insurance
The greatest benefit of health insurance is access to necessary medical care. Health insurance provides access to a comprehensive network of physicians, specialists, hospitals, and laboratories. This network collaborates with you and each other to help you prioritize wellness and prevention. In fact, the majority of healthcare plans include free preventative services, such as immunizations and screenings, to help you stay healthy and avoid illness and its consequences.
Additionally, the Affordable Care Act requires Marketplace plans to cover pre-existing conditions. This means that even if you already have a chronic illness, you will not be denied coverage or charged more for your pre-existing condition. Since you’ll have regular access to the necessary doctors and specialists, your healthcare plan will also assist you in managing the care for any chronic illnesses you may be living with.
Your health insurance provides you with the most effective means of maintaining your health. Having access to this type of continuous care can ultimately result in a longer and healthier life. In fact the mortality rate of adults between 17-64 without health insurance is 40% higher than those without insurance, according to the National Library of Medicine.
Financial Benefits of Health Insurance
Health insurance protects not only your health but also your finances. With an insurance plan, you will have less out-of-pocket healthcare costs, as your insurance will cover your medical services for a monthly premium. You will also be healthier, which will lower your out-of-pocket costs. Consider how much you would pay out of pocket for an unexpected medical emergency Which could easily cost you thousands of dollars.
Working With An EZ Agent
It can be frustrating to organize your own health insurance because there are so many variables to take into account. Why not let a professional do all the hard work for you, for free? A licensed EZ insurance agent can describe the advantages and disadvantages of each plan, and help you choose the best plan for your needs. EZ agents can save you hundreds annually on health insurance premiums. This is accomplished by our ability to search both on and off market for the most cost-effective plans. We can also locate and apply any discounts you may be eligible for. And we don’t stop at finding you a plan; we also assist with plan maintenance after the fact! We can assist you in filing claims with your insurance company and renewing your policy when the time comes. To begin, enter your zip code in the box below or call one of our licensed agents at 877-670-3575.
If you’re looking for a health insurance plan, you probably feel like you’ve had a lot of terminology to learn. Especially when it comes to the out-of-pocket costs that you’ll be responsible for with your plan. It’s true that there’s much more to plans than just monthly premiums. You’ll most likely have to think about copayments, coinsurance, and annual deductibles, as well. And it’s this last expense that we’re going to look at here. Your annual deductible is the amount that you will have to spend on covered medical expenses before your health insurance plan begins to pay its share.
And when it comes to deductibles, you actually have choices. You can choose a high-deductible health plan (HDHP) or a low-deductible health plan (LDHP). But what’s the difference between these types of plans? This article will guide you through the specifics of HDHPs and LDHPs. As well as how to determine which type of plan will serve your needs most effectively based on your needs.
High Deductible Health Plans
A high deductible health plan (also known as a HDHP). As the name implies, is a type of health insurance policy that has a higher annual deductible than other types of healthcare plans. This difference can even be in the four-figure range. Meaning that you will most likely have to pay thousands of dollars out-of-pocket for medical care before your plan will begin to cover any expenses.
With that being said, monthly premiums for these plans tend to be lower than for other plans. And you will still have routine preventive care covered in full before you meet your deductible. As with any ACA-approved plan. The actual deductible you will have if you choose a HDHP will vary depending on your plan and insurance company, but there is a minimum deductible amount for a plan to be considered a HDHP, which changes each year. For 2023, the minimum annual deductible for individuals is $1,500, while the minimum for families is $3,000.
Advantages of HDHPs
As mentioned above, if you choose a HDHP, you will have a plan with a high deductible. But lower monthly premiums. This means that if you know that you will most likely only use the plan for preventive care rather than more extensive medical treatment. You could save money by going with a HDHP.
Other than lower monthly premiums, there is one other big advantage to HDHPs. You can open a health savings account (HSA) in conjunction with a HDHP; in fact, in order to have an HSA, you must have a HDHP. HSAs can be a great way to help pay for your out-of-pocket medical expenses. They are tax-advantaged accounts that can be used to pay for qualified medical expenses that your plan doesn’t pay for. Such as acupuncture and dental expenses. Your contributions to your health savings account are not subject to income tax. And they can be used to reduce the overall cost of your high deductible.
Disadvantages of HDHPs
The high cost associated with these plans is the most significant and obvious disadvantage of HDHPs. If you have a higher deductible, it means that you are responsible for paying a greater portion of your healthcare costs out-of-pocket before your plan begins to contribute. This may put a significant dent in your financial resources. Particularly if you are forced to deal with unanticipated problems relating to your health.
Low Deductible Health Plans
One of the most significant differences between a HDHP and a LDHP is that a low deductible plan typically has a lower deductible. But a higher monthly premium payment.
Because of their lower deductibles, this type of plan is typically chosen by people who see their doctor more regularly. And who need more medical care. If this is the case for you, you might find that the higher amount you’re paying in monthly premiums is balanced out by the low deductible, since once you meet this lower amount, your insurance company will take care of your remaining costs. That could mean you’ll actually end up paying less out-of-pocket. In addition, LDHPs do not qualify for a health savings account (HSA), which is another difference between the two types of plans.
Advantages of LDHPs
Having a plan with a low deductible means you’ll have less to pay out-of-pocket if you need to access healthcare services more frequently, or if you have a true emergency or a catastrophic illness or injury, both of which can be very expensive. People who are older or who have a medical history that includes chronic conditions or illnesses may find that selecting a plan with a low deductible is the better option for them. Others who might benefit from this type of plan include:
Women who are pregnant or who have the intention of becoming pregnant
People who undergo a variety of specialized treatments or need expensive medications, such as those with cancer or on dialysis
Any individual who is contemplating undergoing a surgical procedure within the next year
Disadvantages of LDHPs
Plans with low deductibles tend to have higher monthly premiums, since insurance companies will only cover a greater percentage of your care if you pay a higher premium. These premiums can feel like a burden each month, and if you don’t end up using your plan as often as you thought you might, you could start to feel like you’re wasting money.
Who Should Choose a High Deductible Health Plan?
As we pointed out above, a HDHP might be a good choice for you if you are healthy and anticipate having few to no healthcare expenses. In these circumstances, the lower monthly premiums that you would be paying for your “just in case” plan (which will also cover your preventive care), would save you money over a more expensive plan.
In addition, if you can’t afford a low deductible health insurance plan, you can still get yourself at least some level of coverage with a HDHP. And it’s important to have a plan, even if it has a high deductible, because health insurers negotiate rates with providers. This means you will pay less overall for products and services related to your health if you have health insurance than if you do not have health insurance.
In addition, your high-deductible health plan (HDHP) will pay for necessary medical care, such as preventive services, if you purchase the plan on the individual market. But even if you have enough money to pay for a low deductible health plan, it may be worthwhile to consider a high deductible health insurance plan. Remember that if you have a high deductible health plan (HDHP), you can help to offset your out-of-pocket expenses with a health savings account (HSA).
Who Should Choose a Low Deductible Health Plan?
Again, a health insurance policy with a low deductible is likely to be beneficial to you if you are an older person, if you are not in good health, if you have a chronic condition. If you are planning to start a family, or if you simply make frequent use of your health benefits.
If you have costly health issues, purchasing a LDHP could save you money over the course of the year. Even with the higher premiums. If you switched to a HDHP, the amount you would save in premiums would be a much smaller fraction of the total amount you would pay in deductibles with your HDHP. And, frankly, many individuals find that it is simpler to pay a slightly higher amount on a monthly basis as opposed to a much larger sum all at once. Getting a low deductible health insurance plan might be the best choice for you if you don’t want to deal with the stress of potentially expensive medical care.
How to Choose
It is difficult to make a direct recommendation for a plan without knowing your unique financial situation and your health status. But we can offer the following advice to help you make a decision. Your best bet, though, is to speak to an EZ agent. Who can take your specific circumstances into account and find the best plan for you.
1.Look for discounts
You might be eligible for assistance with your monthly premiums or cost-sharing expenses, depending on your income. So, before you write off a type of plan as too expensive. Ask an EZ agent if you qualify for subsidies or tax rebates.
2.Narrow down your choices
Think about the maximum amount of money you are willing to spend each month on your premium and go from there.
3.Look at additional features
When it comes to shopping for health insurance, deductibles are just one of many factors to take into account. Consideration should also be given to the size of the plan’s network, out-of-pocket maximums, and the structure of the plan. As well as the types of costs that are covered. After you have made a comparison of your expected medical costs for the year with the coverage options available to you. Look more closely at the plans you are considering. Ensuring that they provide the appropriate type of coverage for the amount of money you anticipate spending on healthcare.
4.Set your priorities
Your choice between a high deductible plan and a low deductible plan may come down to what you value more. The ability to save money on premiums if you are fortunate enough to not have many medical expenses. Or the peace of mind that comes from knowing that you won’t have to pay a deductible if you do end up needing more medical care. Doing some number crunching before making your decision might make things simpler for you.
Let EZ Help You
Do you need assistance comparing different plans and choosing the one that is best for your budget and healthcare needs? EZ.Insure is here to help! We will connect you with one of our dedicated, highly trained agents. Who will discuss all of your options with you and assist you in selecting the insurance policy that meets your needs, all at no cost to you. That’s right, there are no hidden fees associated with any of our services. EZ.Insure makes the entire process simple, easy, and quick. To get started, simply enter your zip code in the bar below. Or you can speak to an agent by calling 877-670-3557.
Health insurance can seem like a big expense, but the cost of a plan is nothing compared to the cost of a significant medical issue. That means it’s important to have at least some sort of coverage – but what if you’re struggling to find a plan that you can afford?
In this case, you might want to look into catastrophic health insurance plans, which are designed to provide basic coverage for “just in case” scenarios, and which have affordable premiums. It’s important to note that these plans are not available to everyone, though. In order to purchase a catastrophic health plan, you must be under the age of 30 or meet the requirements for a “hardship” exemption.
Catastrophic plans are really only designed as last resort coverage, but they are a good option if you can’t afford another type of plan, because they will help you avoid a scenario in which you’re hit with a medical bill for thousands of dollars. The monthly premiums for these plans tend to be relatively low, but you will typically be required to pay for all of your healthcare expenses out-of-pocket until you reach the plan’s high annual deductible, which is typically at least a couple of thousand dollars.
Below is an explanation of how catastrophic coverage works, along with its benefits and associated costs, as well as a look at whether this type of plan might be right for you. Once you’ve read through the following, contact an EZ agent with any questions you might have, and to get quotes on the right plan for you.
What Do Catastrophic Health Plans Cover?
Catastrophic plans are like a financial safety net in case you end up incurring large medical bills that would be impossible to pay on your own. They also include coverage for the same preventive care benefits that all ACA-compliant plans offer. This includes coverage for the ACA’s 10 essential health benefits:
Ambulatory patient services
Emergency services
Hospitalization
Laboratory services
Mental health and substance use services
Pregnancy, maternity, and newborn care
Prescription medications
Preventative and wellness services and chronic disease management
Pediatric services
Rehabilitative and habilitative services
WIth a catastrophic plan, you will get most preventive care and up to three doctor visits a year fully covered. You will pay for most other covered services, like lab work and minor surgeries, out-of-pocket until you meet your plan’s high annual deductible. Once you meet your deductible, your catastrophic plan will pay for the rest of your essential health benefits for the rest of the year.
A catastrophic health plan has a deductible that is so high that most people don’t meet it in a given year. These plan’s deductibles are the same as the federally mandated out-of-pocket maximums for healthcare plans, which for 2023 is $9,100.
The good thing is, though, with a catastrophic health plan, as with all health insurance plans, the amount you pay out-of-pocket for medical services will actually be less than if you didn’t have an insurance plan. This is because insurance companies typically negotiate reduced rates with healthcare providers. So, it’s always better to have a plan – even one with a high deductible – than no plan at all.
What Isn’t Covered?
Because catastrophic plans have such high deductibles, they will most not likely not end up covering smaller medical expenses. Costs associated with medical services like treating a broken bone or minor illness, or seeing a specialist, will probably not meet your deductible, so your catastrophic plan will not begin covering your costs.
Who Are Catastrophic Plans For?
As mentioned above, these plans are only available to two categories of people. The first is young adults under 30 who don’t have other coverage options (such as through an employer or spouse). If you are in this category, you might consider getting one of these plans if you:
Are unlikely to need medical care throughout the year
Want to satisfy the legal requirements in your state for health insurance (if your state has a health insurance mandate) but don’t want to buy a more expensive plan
Want to have basic coverage in the event that something terrible does occur
Second, individuals 30 and over who qualify for what is known as “economic hardship,” and who don’t have access to healthcare through an employer or spouse, can also purchase catastrophic health plans. You may qualify for a hardship exemption if you:
Have experienced homelessness within the past three years
Were determined to be ineligible for Medicaid
Have experienced eviction
Have been the victim of domestic violence
Are filing for bankruptcy
If you believe that your current economic situation makes it difficult for you to pay for health insurance and are interested in a catastrophic plan, you’ll have to submit an application for a hardship exemption through the Health Insurance Marketplace.
It is important to keep in mind that even if your income puts you in a position to receive reduced healthcare costs, also known as a subsidy, you will not be able to put those savings toward a catastrophic health plan. This includes tax credits for premiums, as well as subsidies for cost-sharing. That means that no matter your income, your monthly premiums for your catastrophic insurance plan will remain the same.
The Cost
A catastrophic health plan is essentially the same thing as a high deductible health plan but with a different name, and with restrictions on who can purchase them, as already discussed. Because they have such high deductibles, they can be quite expensive if you have a number of health problems.
As of 2023, the annual deductible for individual catastrophic health plans is $9,100; for families, this doubles to $18,200. This means that you will most likely have to pay out-of-pocket for most smaller medical expenses, including lab work, minor surgery, or anything else other than preventive care.
The one good thing price-wise about these plans is that plans with high deductibles generally have relatively low premiums. So if you are healthy and don’t often see the doctor, the monthly cost might be worth it as coverage in case of an emergency, since a major medical event can be extremely expensive.
Pros of Catastrophic Health Plans
The following are some of the benefits of having a catastrophic health insurance plan:
In comparison to those of other types of health insurance, the monthly premiums are typically much more affordable.
Your coverage acts as a financial buffer, protecting you from the potentially catastrophic effects of a major illness or medical emergency.
If you are generally healthy and don’t require many medical services, you might find that your overall insurance and care costs are lower than they would be with either another plan or no plan at all.
Insurance companies typically negotiate lower rates for services with healthcare providers, so your out-of-pocket costs for care could be lower with a plan than they would be without one.
When determining whether or not a catastrophic plan is the best option for you, your current state of health is an important factor. If you are generally healthy, a catastrophic plan may be a good option. This is especially true if you have an emergency fund that can pay for any medical care you require up to the amount of your plan’s deductible.
Cons Of Catastrophic Health Plans
It’s important to note that catastrophic health insurance plans come with a number of significant drawbacks, including the following:
Because you will only be covered for preventative care, a limited number of visits to primary care providers, and the most expensive type of care, the benefits of your medical coverage will be severely limited.
Because your deductible will be very high, you will need to come up with a significant amount of money in the event that you require medical services, which can be a problem for a lot of people.
You will not be eligible for premium assistance through the Affordable Care Act (ACA).
You will not be able to open a health savings account (HSA), as you would be able to do with other qualified high-deductible health plans. With a health savings account (HSA), you can set aside money before it is taxed to use for medical expenses.
A catastrophic plan is not the best option for you if you are planning to have a baby or otherwise anticipate needing a significant amount of medical care during the course of the year.
Are Catastrophic Health Plans Worth It?
A catastrophic health insurance policy could be beneficial to have if you cannot obtain health insurance from another source. In this case, one of these plans will typically be the most cost-effective option, and it may be significantly less expensive than other available choices, such as COBRA coverage. A lot of people use this type of plan as a short-term solution for their emergency insurance needs.
It is most likely worthwhile to purchase a catastrophic insurance policy, since they have low premiums. Having one will protect you from incurring potentially bankrupting medical expenses in the event of an emergency or illness.
Working With EZ
If you find yourself in a bind, EZ.Insure is here to assist you. Our agents are incredibly knowledgeable. They can comb through all of the health insurance plans available in your area to find the right one for you. As quickly as possible and with no hassle to you. A personal agent will assist you in navigating the numerous coverage tiers and plan options available, and answer all of your questions. And the best part is that everything we do is totally free! To get your free quotes, simply enter your zip code into the space below. Or give us a call at 877-670-3557.
There are a lot of moving parts involved in health insurance. As well as a lot of terminology to learn in order to understand your plan and its costs. Two of the most important terms to understand are premiums and deductibles. These are the two out-of-pocket expenses associated with your health insurance plan that will end up costing you the most money. Understanding these two terms, the difference between them, and how each operates will help you to better choose the best plan for your budget. Below we’ll explain how these two health insurance costs are interdependent and have an impact on each other.
Premiums
Like a Netflix or Spotify subscription, premiums are a monthly payment you make to maintain a service. In this case your health insurance plan. If you purchase an individual plan on the Health Insurance Marketplace, you will pay your premiums in their entirety. But you might be eligible for subsidies or tax rebates. If your employer offers a group health plan, the cost of your health insurance premiums may be partially or entirely covered by your employer.
How much you pay in premiums will vary based on several factors. Such as the policy you choose, the number of people in your family, and the insurance company you go through. In addition, when determining your premium, insurance companies may take into account factors such as your age, where you live, and whether or not you smoke cigarettes. For instance, because healthcare costs are assumed to increase with age, premiums for older adults are higher.
Premiums for individual health plans and family health plans function in the same way. There is only one payment required each month, so the cost itself is the only difference. The cost of your premium will be higher the more people who are covered by it. But, if you do the math, you might find that you’re paying less per person for a family plan than you would if you all had your own separate plans.
The only time this might not be the case is when someone in your family has significant health issues and another person rarely sees the doctor. In this case, it might be better to find plans that have lower premiums and higher deductibles for the healthier family member. And a plan with higher premiums and a lower deductible for the family member who needs more medical care. Let’s see why by taking a closer look at how deductibles work.
Deductibles
In most cases, your insurance plan will have an annual deductible. Which you will have to meet before your health insurance begins paying for any of your medical care costs. “Meeting” your deductible means that you will have to pay that amount in covered expenses to get coverage for anything other than preventive care. So, if your plan has a $2,000 deductible, for example, you’ll have to pay $2,000 out-of-pocket for things like lab work, minor surgeries, tests done at your doctor’s office, etc., and then your insurance plan will begin covering those things.
There are a variety of ways deductibles can work, and which medical expenses will count towards meeting them. Health insurance policies for individuals and families may include a deductible structure. In which the insurance company is not obligated to pay for services until the deductible has been met. But in some cases, a plan may cover some medical expenses before the deductible is met while excluding others. In addition, certain expenses like copayments won’t count towards your deductible.
Individual vs. Family Deductibles
Health insurance deductibles can either be applied per person or per family. The way individual deductibles work is fairly straightforward, while family deductibles can be a bit more complicated.
Individual – First, the easy part. If you have an individual health insurance policy, the money you spend on qualified medical expenses will count toward meeting your deductible. Once your plan’s deductible is met, you and your insurance company will begin dividing the remaining costs. Meaning you will pay what’s known as “coinsurance,” or a certain percentage of each bill. You’ll do this until you reach your policy’s out-of-pocket maximum.
Family – This is where things can get confusing, because your plan might have both an individual deductible and a family deductible. There are two main categories of family deductibles: embedded and aggregate. An aggregate deductible works the same as an individual deductible. Your plan will have one deductible, and everyone on the policy will be paying towards it.
Embedded deductibles, though, is where the confusion sometimes comes in. With an embedded deductible plan, there is both a family deductible and an individual deductible. So, each member of the family has a separate deductible in addition to the family’s deductible. Once a family member’s deductible is met, the insurance policy begins covering 100% of that person’s healthcare costs. Everyone else in the family will still have to meet their own deductible after that member’s deductible is met.
In addition, there is also a family deductible with these plans. And all family members will begin to have their expenses covered once the family deductible is met. Everyone will have to only pay their coinsurance until the out-of-pocket maximum is reached, once the family deductible is met.
Costs
The cost of your premiums and the amount of your deductible will depend on a variety of factors. It is difficult to give an accurate estimate of what you’ll pay without knowing your unique circumstances. Wut we can say that the average monthly premium price in the country is $456 per month.
Check out our state-by-state health insurance guides to learn more about how the health insurance market is regulated in your state. And to get a baseline estimate of the costs. You can also learn more about the health insurance plans that are available in your state. As well as ways to reduce the cost of your coverage.
As for deductibles, the average nationwide deductible amount depends on the metal tier you choose for your plan: Bronze, Silver, Gold, or Platinum. Keep in mind, lower deductibles mean a higher premium.
The average annual deductible amount for each tier is as follows:
Bronze – $7,482
Silver – $4,890
Gold – $1,650
Platinum – $745
How Premiums and Deductibles Work Together
Insurance premiums and deductibles are interrelated costs. Your plan’s premiums will be higher if the deductible is lower, for example. So, generally, your plan will either have a higher monthly premium with a lower deductible, or a lower premium with a higher deductible.
If you’re wondering which type of plan would be better for you. Consider that a higher premium with a lower deductible would be more appropriate for someone who has a pre-existing condition and needs to see the doctor frequently. And if you don’t often see the doctor or generally spend a lot on medical services, having a higher deductible won’t be as much of an issue for you. And you might be better off spending less on your premiums.
FAQs
How can I lower my premiums?
If you have individual coverage, and your household’s annual income is less than or equal to 400% of the federal poverty level, you might be eligible for subsidies or tax rebates. Which can lower the price of your premiums. If you have group health insurance through your employer, they might offer you reduced health insurance premiums or other incentives if you are able to meet certain health and wellness criteria.
What will increase my premiums?
Your health insurance premiums may increase for a variety of reasons. Including but not limited to inflation, adding family members to your plan, and relocating to an area with a higher cost of living. It’s also possible that your monthly health insurance premiums will go up if you opt for a plan with more generous benefits. Consider the policy’s premium in light of its benefits before making your decision.
Are premiums tax deductible?
If you have a plan through either the federal or state Health Insurance Marketplace, your premiums are tax deductible. If you’re self-employed, health insurance premiums are tax deductible. And you may also be able to deduct the premiums you pay for long-term care insurance. Before submitting a tax deduction claim, you may want to consult a tax expert.
Is a high or low deductible plan better for me?
If you do not anticipate having many medical expenses during the next plan year, selecting a health insurance policy that has a high deductible could give you the best value. When you anticipate having a lot of medical expenses in the near future, such as if you plan on having a baby, selecting a plan with a low deductible could help you get the most value out of your coverage.
What does “no-charge” deductible mean?
If you have a plan with a “no-charge” deductible, your plan will pay 100% of eligible medical expenses after you meet your deductible for the year. No-charge deductibles tend to be higher. But if you plan on using a lot of medical services for the year, it might balance out when you are no longer required to pay anything out-of-pocket.
How EZ Can Help
EZ.Insure provides access to local, highly trained insurance agents. Who will shop around for the best policy at the most affordable price. We can save you hundreds of dollars a year by searching both on and off the Marketplace for a plan that fits your needs. We can also find out if you’re eligible for any local discounts. And then apply them to your plan for you. And the best part is that we do all of this for free! To find out how much you could be saving, simply enter your zip code on the box below for free, instant quotes. Or call us at 877-670-3557 to speak to an agent who can answer all of your questions and find you the perfect plan.
