Many people do not see the importance in scheduling an annual physical, especially if they’re in good health. However, regular exams are essential to your continued health no matter what age you are. These exams allow your doctors to monitor your health, make necessary adjustments to your medications, and prevent serious health conditions from developing or worsening. Annual exams don’t only help you get healthy but they can also save your life.
What To Expect From Your Annual Physical
An annual physical is a general checkup that looks at your health as a whole. Your PCP will look at your medical history as well as your vital signs such as your heart rate, temperature, and blood pressure. During the visit your doctor will also give you a full physical check. Depending on how old you are and how healthy, your doctor may order more tests. These could include things like cholesterol and blood sugar tests from a lab. It may also include ultrasound tests to check for breast cancer, lung cancer and osteoporosis.
Your doctor will be able to look for common problems that come with aging and make treatment plans if needed. During your physical exam you can also talk to your doctor about lifestyle changes you can make to be healthier. Such as advice on nutrition and exercise. There are several essential reasons to use your yearly physical exam.
Establishing Your Health Baseline
One of the more important things about getting regular physicals is that you and your doctor can learn more about your current health and spot any risks early on. Over time your doctor will check and monitor each of your vitals at each visit. This establishes your health baseline letting your doctor become familiar with what your body’s “normal” is. It helps your doctor know you and your body so they can spot any unhealthy trends early. They will keep an eye out for any significant changes to your health so they can treat it immediately.
Updating Your Vaccines
Vaccines are not just something that kids need. Adults also need to make sure they’re up to date on them as well. Your doctor will keep track of these vaccines at your physical exam and let you know when it’s time to update them:
Covid-19 vaccine and boosters – This vaccine helps people from getting sick or dying from COVID. Everyone age 5 and up should get the vaccine as well as the booster shots as they become available.
TDAP vaccine – The TDAP vaccine protects against tetanus, diphtheria and acellular pertussis (whooping cough). This is a shot you get as a kid but adults need a repeat shot every so often. And pregnant women need this shot every pregnancy.
Flu shot – Flu shots are recommended every year from the time you turn 6 months old.
HPV vaccine – Cancers caused by the human papillomavirus are stopped by the HPV vaccine. In the past few years, the advice that girls and boys ages 11 to 12 get an HPV shot hasn’t changed. But the CDC now says that all women and men up to age 26 should get a catch-up HPV shot. Adults between the ages of 27 and 45 who haven’t gotten the vaccine before might also benefit from a “catch-up” shot.
Pneumonia vaccine – If you have asthma, smoke, or are over 65, your primary care doctor (PCP) may suggest the pneumonia vaccine to keep you from getting a lung illness.
Shingles vaccine – Almost anyone 50 and older is encouraged to get the shingles vaccine every 5 years.
Hepatitis B vaccine – If you have diabetes or another disease that affects your immune system, work in the healthcare field, or live in a group setting like a nursing home, your doctor may suggest that you get the hepatitis B vaccine.
Medication Management.
Any medication that you take every day can sometimes need to be adjusted. This can happen due to your body building an immunity to the medication or your health declining. Your doctor will look over your medications at your annual physical as well as consider any new symptoms you’ve discussed during the visit to decide if they need to increase, stop, or add medications to your treatment plan. They will also monitor to make sure you never take 2 medications that will negatively affect each other.
Updating Medical Records
Your medical records aren’t just paperwork. These records keep an in-depth record of your health history so that it’s easy to compare your current health to the past to help identify health trends. Your Medical records include things like:
History of medication changes
Allergies
Vaccines
Family health history
Past surgeries
Treatment plans
Test results
Weight loss/gain trends
Current health conditions
These records also come in handy if you switch doctors or need to see a specialist, your new doctor will have all the information they need to treat you properly. Medical records are also extremely important in an emergency situation. If you’re unable to speak, your records can help emergency room doctors and surgeons treat you accurately and quickly without accidentally making any health conditions worse. Such as giving you a medicine you are allergic to or that will react badly with current medications. As well as let them know any existing conditions that they might need to be aware of during an emergency surgery.
Building Trust With Your Doctor
Your PCP is your partner in health care. An annual physical check is a great way to get to know your PCP and let your provider get to know you. This one-on-one time with your doctor is a great way to connect and build trust with your doctor. Even if you see your primary care provider for minor illnesses and injuries at other times of the year, these “sick-care” visits are generally about treating specific problems.
During your yearly physical, your health as a whole and the preventive care you need to stay healthy are the main concerns. In addition to learning more about you and how you live, your PCP will give you plenty of time to talk about any worries or questions you may have about medications, treatment plans, or other health problems. The American healthcare system can be complicated, so having a doctor you trust to guide you through it is invaluable.
Saving Money
Some people say that getting a checkup once a year is a waste of money, however getting a checkup once a year at the office of your general care doctor can save you money in the long run. Getting a physical once a year can help keep medical costs down in the future. If your doctor finds a disease or sickness before you feel sick, it will cost less to treat you than if you wait until you feel sick. It’s easier and cheaper to stop a problem from happening than to fix it afterward. Early diagnosis is important for both your health and your bank account. When you make an appointment for your yearly physical, you’re making a cost-effective choice.
How To Get The Most Out Of Your Physical Exam
If you only see your doctor once a year, make the most of it by knowing your family’s medical background and telling your doctor about it. Tell your doctor if someone in your family has been told they have a sickness or cancer. Also, bring a list or a bag with you that has all of the medicines and vitamins you take. This will help your doctor check for possible drug combinations and make sure you are taking the right amount of each drug. Don’t be afraid to talk about changes in your health, even if you think they are small. Some examples would be changes in how you sleep, what you eat, or how you feel. Don’t just worry about your physical health and forget about your mental health.
Getting Health Insurance
Preventative care is a “freebie” built into almost all health plans. Meaning these yearly exams are often free with the right health insurance. A qualified EZ insurance agent can explain what each health plan’s pros and cons are. And help you come up with the plan that works best for you. Working with an agent saves you time and stress because you don’t have to try to figure out legal jargon or read small print. Agents do all the hard work, so you can relax knowing that your coverage will meet your financial and medical needs the best.
Not to mention that EZ agents can save you hundreds of dollars a year on your health insurance bills. We do this by being able to look for the cheapest rates both on and off the market. Our agents can also find and use any savings you might be able to get. We don’t just help you find a plan, though, we also help you keep it up to date. We can help you make claims with your insurance company and help you renew your policy when it’s time. To get started, just type your zip code into the box below or call 877-670-3557 to talk to one of our certified agents.
Oral hygiene is actually considered preventative care, just like annual physicals and routine blood work. If you take good care of your teeth and gums, you can stop dental health problems like cavities, gum disease, and even bad breath. Not to mention it helps stop other health issues as well. Oral health is also related to your entire body’s health. For example, if you have an infection in your mouth, the bacteria can actually travel through your bloodstream to other parts of your body. This bacteria can lead to heart disease and strokes. So, taking care of your mouth is an important part of staying healthy in general. Below we’ll look closer at how healthy mouths mean healthy bodies, as well as tips on how to take care of your teeth between dentist visits.
Reduce Risk Of Disease
When we talk about our overall health, we don’t usually think about our teeth and gums. But we really should! Taking care of your mouth can make you less likely to get sick. Research shows that gingivitis or periodontitis (forms of gum disease) can lead to a number of health problems.
Cardiovascular Disease
Healthy gums are one way to lower your risk of heart disease. Periodontal disease is a direct cause of inflammation in your arteries. When the bacteria from your mouth gets into your bloodstream, it causes the arteries to harden. In turn, this increases your risk of heart attack or stroke. Bad oral health is also linked to high blood pressure and dense LDL cholesterol, which raises the risk of heart disease even more.
Bad oral hygiene will inevitably lead to inflamed gums. When oral bacteria travels to the brain, it can actually kill your brain cells! This leads to memory loss. It’s currently estimated that around 40 million people are currently living with Alzheimer’s or dementia worldwide. A pathogenic oral bacteria called spirochetes has been studied as a possible cause of Alzheimer’s disease. This is because significantly more spirochetes bacteria are found in Alzheimer’s patient’s brains than those without Alzheimer’s.
According to the American Diabetes Association (ADA), 37.3 million Americans currently have diabetes, with many more unaware that they even have it. Periodontal diseases can increase the risk of developing or worsening diabetes. This is because periodontal disease makes it difficult for your body to regulate your blood sugar. Just like periodontal disease can cause or worsen diabetes, diabetes can also cause periodontal disease. If you have diabetes it can increase your risk of dental problems that can then offset other health problems. This is because Diabetes increases the risk of infection. In fact 95% of diabetic adults also suffer from periodontal disease.
High-Risk Pregnancy
Researchers have discovered a direct link between gum disease in pregnant women and low birth weight and preterm labors. Premature or low weight infants are susceptible to brain injuries, as well as vision and eyesight problems. Just like with diabetes not only can gum disease cause issues with your pregnancy, your pregnancy can cause issues with your teeth and gums. So it’s important to take close care of your teeth if you’re pregnant or plan to become pregnant. These issues include:
Gingivitis – This is more likely to happen during your second trimester. Symptoms include gum swelling and bleeding, specifically when brushing and flossing your teeth.
Periodontal disease – This is an infection of the structures that support your teeth (gums, ligament, and bones). It happens as a result of untreated gingivitis and can lead to losing your teeth.
Pregnancy Epulis – This is a red, round growth around your gums that can easily begin to bleed.
Tooth Decay – Your pregnancy hormones relax the ring that holds your food inside your stomach. If you suffer from gastric reflux or vomiting from morning sickness, your stomach acids can coat your teeth. Repeated vomiting and reflux can damage your tooth enamel and increase the risk of tooth decay.
Obstructive Sleep Apnea
Teeth grinding is one of the first signs of obstructive sleep apnea. Grinding your teeth can lead to tooth decay and inflamed gums, increasing your risk of infection. Sleep apnea is also directly linked with hypertension, heart disease, and headaches.
Respiratory Issues
When oral bacteria is inhaled into your lungs or absorbed in your bloodstream it can cause some serious respiratory problems. Bacteria can cause respiratory infections, bronchitis, pneumonia, COPD, and lung disease once it’s in your lungs.
Cancer
Cancer is another issue related to oral health. Researchers have discovered that periodontitis can contribute to the development of pancreatic cancer. The bacteria that cause periodontitis can be dangerous, as they damage the tissue surrounding the teeth. Adults with poor oral health were more likely to contract an oral virus that can cause human papillomavirus (HPV), which can also cause cancer. Periodontal disease can also cause lung and blood cancer.
Rheumatoid Arthritis
Rheumatoid arthritis is an inflammatory disease, as we know poor oral hygiene can lead to periodontal disease which causes inflammation in the mouth that eventually spreads to the rest of the body. John Hopkins investigated the link between poor oral health and rheumatoid arthritis. The inflammatory response of joints in Rheumatoid Arthritis patients is comparable to the inflammatory response of a patient’s mouth with Periodontal disease.
Osteoporosis
If periodontal disease gets bad enough, the inflammation and infection can cause a loss of bone tissue. Studies reveal that periodontal disease affects all of the body’s bones, not just the jawbone and teeth. Both osteoporosis and periodontal disease are associated with estrogen deficiency, low mineral bone density, and low vitamin D levels according to the research.
Erectile Dysfunction
Poor oral health can even affect your sex life! Periodontal disease creates infection-prone pockets in your mouth. With the presence of bacteria and infection in your bloodstream, your blood vessels can become inflamed and block blood flow to your genitals. In fact, men with periodontal disease are three times more likely to experience erectile dysfunction than men with healthy mouths.
Signs of Poor Oral Hygiene
Poor oral hygiene manifests itself in a variety of ways. Including bleeding, swollen gums, toothaches, and abnormal growths. Here are some of the most common indicators that you aren’t brushing or flossing properly.
Tooth Pain
If you have tooth pain, the last thing you want to do is ignore it. Even if you immediately start brushing and flossing more, it’s likely that the pain will continue. Tooth pain is frequently the result of serious tooth decay. Once the decay reaches the tooth the only way to stop it is with a dentist’s help. Tooth pain can also be a sign of:
Chipped, broken, or fractured tooth
Ill fitting crowns
Abscess
Infection
All of which can begin to cause other dental and overall health problems.
Bleeding/Swollen Gums
Bleeding, swelling, and color changes in your gums are all indications of poor oral hygiene. There may be an underlying problem with your gum health. If you’re in the beginning stages of gum disease, only a dentist can find out for sure. Treating your gums will prevent the disease from spreading to the point that your gums recede and your teeth begin to fall out.
Changes In Your Tongue
Changes in the texture or color of the tongue indicate either poor oral hygiene or deteriorating oral health. Every single night, you must thoroughly brush your tongue. If you dread cleaning your tongue due to the gag reflex, use a tongue scraper instead. If you notice changes in your tongue after your nightly brushings, consult your dentist.
Growths
Some patients experience oral growths along their gums. Others don’t notice them until a dentist points them out. Finding and treating abnormal growths is very important. These growths can easily lead to oral cancer.
Bad Breath
Nobody enjoys bad breath. While you can try to use gum or mints to mask it, taking care of your teeth is the best way to prevent it. When you don’t brush or floss properly food particles can get stuck in your mouth and create the odor. Even when not eating, a sticky film of bacteria called plaque will begin to form on your teeth which will also cause bad breath. This plaque will irritate your gums and ultimately lead to tooth decay.
Improving Your Dental Health
After all of that, you’re sure to want to start taking better care of your mouth and you can start immediately.
Brush your teeth 2x a day – Brush with fluoride toothpaste and a soft bristled toothbrush. This helps remove plaque and bacteria from your gum line. Make sure to brush every surface of your teeth including the backs and sides.
Floss 1x a day – Brushing alone won’t reach all of the spaces between your teeth. To get to those areas you’ll want to take about an 18 inch piece of floss, wrap it around your middle fingers and use your thumb and forefingers to slide the floss between each tooth.
Brush your tongue – Your tongue essentially acts like a sponge for bacteria. When you brush your teeth you’ll want to brush your tongue as well. Using either a toothbrush or tongue scraper.
Use mouthwash daily – Antibacterial mouthwash will stop harmful bacteria from growing. It also helps get rid of food and plaque that is stuck to your teeth.
Quit smoking – Tobacco use is the leading cause of periodontal disease and oral cancer. These products are best avoided altogether. If you currently smoke and wish to quit, consult your healthcare provider about available treatment options.
Visit your dentist regularly – Exams and cleanings of the teeth on a regular basis are essential for good oral health. Many patients benefit from six-month visits. However, if you are prone to cavities, gum disease, or other oral health issues, you may need to visit your dentist more frequently.
Working With EZ
Dental insurance may not always appear to be necessary. However, it is, because dental health can impact overall health. Gum disease, if left untreated, can lead to heart problems, strokes, and respiratory issues. Having dental insurance will allow you to maintain a healthy mouth and body without worrying about costly medical bills. To begin searching for dental insurance, please enter your zip code below or call one of our licensed agents at 877-670-3557.
A cost-sharing reduction is a discount that reduces your deductibles, copayments, and coinsurance. They help reduce your out-of-pocket health care costs. Individuals qualify for health insurance coverage through the ACA Health Insurance Marketplace. Approved individuals receive discounts to assist with their deductibles, copayments (copays), and coinsurance, and to reduce their maximum out-of-pocket expenses for covered medical expenses.
Whether you qualify for these discounts depends on the size of your household and your income. As well as the plan you choose, since the only plans that have cost-sharing reductions are Silver plans. Your eligibility is determined when you enroll in your health plan.
How Cost-Sharing Reductions Work
Cost-sharing reductions reduce the amount of out-of-pocket expenses that you’re responsible for, thus making your insurance more affordable. Under Obamacare, anyone who qualifies for these discounts will have altogether lower out-of-pocket expenses when they apply for a Silver plan on the Marketplace. Any copayments, coinsurance, or deductibles associated with the plan you choose will decrease. They also increase the actuarial value of the plan.
We’ve given examples of these discounts below. However, it is important to note that the amounts below are just to show you how they work. The actual costs and discount will vary depending on the plan you choose and your income. Keep in mind that there is a large variety of deductibles, copay, coinsurance, and out-of-pocket maximums across all plan categories.
Lower Deductible
A lower deductible means that your insurance company will begin to pay its portion of your medical expenses much sooner. For instance, if you choose a Silver plan with a $750 deductible. You are responsible for the first $750 of medical expenses. Once you’ve met the deductible your plan begins paying its portion. However, if you qualify for a cost-sharing reduction, that $750 deductible could turn into a $300-$500 deductible.
Lower Copays or Coinsurance
Copayments are the payments you make each time you receive care. Such as $30 for a doctor’s appointment. If your copay under your Silver plan is $30 and you qualify for the discount then you may end up only having to pay $15 instead.
Lower Out-Of-Pocket Maximum
An Out-of-pocket maximum is the total amount you would have to pay in a year for healthcare. With a cost-sharing reduction your plan’s out-of-pocket maximum could go from $5,000 to $3,000. Meaning you’ll effectively have much less to pay per year.
Silver Loading
Historically, the federal government reimbursed health insurance companies directly for cost-sharing reductions. This ended in the fall of 2017, but eligible enrollees have continued to receive cost-sharing subsidies.
Most insurers simply add the cost of cost-sharing reductions to Silver plan premiums to cover the expense. This strategy, known as “Silver loading,” results in larger premium subsidies for everyone in the area, as premium subsidies are based on the cost of the second-least expensive Silver plan in each area.
Cost-Sharing Tiers
The Silver Plan standard covers 70% of your out-of-pocket expenses. If you are eligible for cost-sharing reduction, you may be eligible for the Silver 73, Silver 87, or Silver 94 plan. The Silver 73 plan covers 73% of your out-of-pocket expenses, 3 percent more than the standard Silver plan. However, if you qualify for a Silver 87 or Silver 94, you will receive coverage for 87% or 94% of your out-of-pocket expenses, which is 17% or 24% more than the standard Silver Plan. Rarely would it make sense for cost-sharing reduction-eligible individuals to purchase the Gold Plan. If you are eligible for the Silver 87 or 94 plan but choose the Gold plan, you will pay higher premiums for fewer benefits. The Silver 94 plan is superior to the Platinum plan, which covers 90% of out-of-pocket expenses.
Who Qualifies For Cost-Sharing Reductions?
Cost-sharing reductions are available to eligible Marketplace enrollees who select Silver plans. Your household income needs to be below 250% of the federal poverty level (FPL). In states that did not expand their Medicaid, the lower income threshold is 100% of the poverty level, while in states with expanded Medicaid the lower income threshold is at 138% of the FPL. If your income is low enough to qualify for Medicaid you will not be eligible for a cost-sharing reduction. Additionally you must be a citizen or an immigrant who has lived here legally for at least 5 years.
Native American Cost-Sharing Reductions
Cost-sharing reductions work a little differently for Native Americans. Members of federally recognized Indian tribes receive an additional set of cost-sharing advantages. As long as their household income is less than 300 percent of the Federal Poverty Limit, these households qualify for zero cost-sharing plans. These plans have no copayments, deductibles, or coinsurance when receiving care from an Indian healthcare provider or any of the Marketplace’s essential health benefits.
What Is An Actuarial Value (AV)?
The AV of a plan is the average percentage of total healthcare costs that the plan will cover. A consumer enrolled in a Silver plan with a 70% AV would be responsible for paying an average of 30% of their actual healthcare costs, with the insurer covering the remaining 70%. Since these actuarial values are based on the average number of enrollees, the actual percentages for each household will vary considerably based on their total healthcare costs. In general, the lower your expected healthcare costs, the lower the AV value, as you are responsible for the deductibles prior to the insurer picking up the tab.
How To Apply For a Cost-Sharing Reduction
If you are eligible when you apply for a Silver plan you are automatically enrolled with the cost-sharing reductions built into your plan. Therefore, the lower out-of-pocket maximum and higher actuarial value are automatic as long as you choose a Silver plan. You will only see Silver plans with the cost-sharing reductions built in if you are eligible for them. If you have a higher income you will only be shown standard Silver plans.
If I’m Eligible for a Cost-Sharing Reduction, Is A Silver Plan Best For Me?
There is no correct or incorrect response. A person earning 240% of the poverty level and a person earning 140% of the poverty level are both eligible for cost-sharing reductions benefits, but they will receive vastly different benefits. If your income falls within the range where the plan’s AV will only be increased to 73%, it may be prudent to enroll in a less expensive Bronze plan, saving money on premiums (or even getting a plan for free) in exchange for slightly higher out-of-pocket costs.
Depending on your income and location, it is also possible for you to qualify for a Gold plan with no premium. You would need to compare this carefully with the available Silver plans and their built-in cost-sharing reductions benefits, taking premium differences into account.
But if your income is on the lower end and you’re eligible for strong cost-sharing reductions benefits (i.e., your income is under 200% of the poverty level), you should strongly consider the Silver plans that are available to you, even if there are free Bronze plans available as well (if your income is under 150% of the poverty level, you’ll also be eligible for premium-free Silver plans with built-in cost-sharing reductions benefits in most states). Consider the amount of out-of-pocket expenses you will incur if you require medical care during the year. It will be significantly higher on the Bronze plan, which could quickly wipe out any savings from the lower monthly premiums.
What If My Income Changes?
If your income changes after enrollment and makes you eligible or ineligible for cost-sharing reductions, you will be able to change your plan during a Special Enrollment Period (SEP). However, this option is only available if you were previously enrolled in a Marketplace plan or Medicaid. If you chose to enroll in a health insurance plan outside of the Marketplace, you will not be eligible for a SEP.
If I Don’t Qualify, Are There Other Assistance Options?
Even if you do not qualify for cost-sharing reductions, you may still be eligible for premium tax credits to assist with your health insurance costs. Premium tax credits are a type of subsidy that reduces your monthly premium payments and are available to those with incomes between 100 and 400 percent of the federal poverty level. This means that if you qualify for cost-sharing reductions, you will likely also be eligible for premium tax credits and be able to reduce your health insurance costs further.
Working With EZ
If you qualify for a cost-sharing reduction, the amount of money you will save is determined by your specific income estimate. The lower your income, the greater your savings. Once you speak with an EZ.Insure agent, they will determine if you qualify for additional discounts. As well as guide you in the right direction. Our highly trained and knowledgeable agents will assist you in shopping, comparing, and enrolling in the best plan for you or your family. We guarantee to help you save money without requiring you to deal with multiple agents and companies. We simplify the process for you. Enter your zip code below to receive free instant quotes, or call 877-670-3557.
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.
Because of the constant yearly rise of health services and health insurance premiums, healthcare has become a large portion of everyone’s personal budget. However, as these costs have increased over the last few decades, medical savings accounts have come into play to help offset them. There are a few different accounts you can choose from to help you save money towards your healthcare, but we’re only going to be looking at 2 of them: Health Savings Accounts (HSAs) and Flexible Spending Accounts (FSAs). Both HSAs and FSAs are savings accounts that allow you to save specifically for medical expenses. Aside from that fact, the two accounts differ in a number of significant ways. In this article we’re going to compare and contrast them so you get an idea of what they are, how they work, and if one of them would be beneficial to you.
Health Savings Accounts (HSAs)
Health Savings Accounts are not typical savings accounts, and they are only available to people with a high-deductible health plan (HDHP). As of 2023 an HDHP is defined as any plan with a minimum deductible of $1,500 for individual coverage or $3,000 for family coverage with an out-of-pocket maximum of $7,500 and $15,000 respectively. An HSA is a triple tax advantaged account that can be used to pay for qualifying medical expenses. It’s known as “triple tax-advantaged” because your contributions to your account are not taxed, the money in the account is never taxed while it’s in the account, even if it earns interest or investment returns.
Additionally, as long as you use your HSA funds for qualified medical expenses, your withdrawals will also never be taxed. However, if you use your HSA funds for anything besides qualified medical expenses you will have a 20% tax penalty. Another great thing about HSAs is that you can actually invest your funds as well, similar to the way you would a 401K. This lets your HSA actually make you money, if you invest properly you could end up with a nice health savings account keeping you from having to pay for little to any of your healthcare.
How HSAs Work
If you open an HSA with your HDHP, you will deposit money into the HSA that you can use to pay for qualified medical expenses that your health plan does not cover. Which are any services that the IRS recognizes as a eligible medical costs these expenses include:
Acupuncture
Ambulance services
Birth control/contraceptive devices
Blood pressure monitors
Blood sugar test kits/test strips
Chiropractic therapy/exams/adjustments
Contact lenses
Copayments
Dental care
Dermatological services
Diagnostic services
Eye exams
Eye surgery
Flu shots
Gynecological care
Incontinence supplies
Infertility treatments
Insulin and diabetic supplies
Laboratory fees
Lactation expenses
Legal sterilization
Laser eye surgery/ LASIK
Menstrual care products
Nasal strips
Obstetric care
Over the counter (OTC) treatments containing medicine (i.e., cold treatments, pain relievers, sinus medications, etc.)
Physical exams
Pregnancy test kits
Smoking cessation programs
Therapy or counseling
Treatment for alcohol or drug dependency
Vaccinations
Vision care
Wrist supports/elastic straps
X-ray fees
You can use the HSA funds to pay all your medical bills until you reach your plan’s deductible, and then you can use them to cover your coinsurance or copayments until you reach your annual out-of-pocket maximum. Additionally, unlike other health spending accounts, HSA funds will never expire. Your funds roll over into the new year, every year so you don’t have to rush to spend the money in the account. One thing you should note though, is that HSAs do have a contribution limit, these limits change annually but as of 2023 if you have an individual plan you can only contribute up to $3,850 for the year. For family plans the limit is $7,750.
Flexible Spending Accounts (FSAs)
A Flexible Spending Account, sometimes called a Flexible Spending Arrangement, is a type of savings account that offers you specific tax advantages. You don’t actually set these accounts up, instead they are set up by your employer. FSAs let you contribute a portion of your pay into the account. Your employer can also choose to contribute to the FSA on your behalf, sort of like when your employer matches your 401K except the employer decides exactly how much they contribute. The FSA funds are then used to reimburse you for eligible medical and dental expenses.
How FSAs Work
An FSA is a voluntary plan that allows employees to contribute up to $3,050 a year (as of 2023) to pay for eligible medical expenses that are not covered by their health insurance plan such as:
Health insurance copayments
Doctor’s visits
Coinsurance payments
Dental work
Vision expenses
Prescriptions
Therapy and counseling services
Chiropractic care
Acupuncture
Hospital fees
Surgery costs
Diagnostic services
Allergy testing
If your employer offers group health insurance they can also offer these FSA plans as an additional employment benefit. Your employer can choose to also contribute to your FSA, they can choose to match your contributions or decide to pay a smaller amount. They are not required to contribute though, so some employers might not add into your FSA at all. If your employer does choose to contribute, their contribution typically won’t count towards your yearly limit no matter how much they contribute.
The Differences
You can’t have both of these plans at the same time, so if your employer offers an FSA but you’re also considering an HSA, you’ll want to keep these key differences in mind when you’re making your decision.
Qualifications
Compared to FSAs, HSAs have stricter eligibility requirements. To qualify for an HSA, you must have an HDHP. The HDHP has to be your only health insurance. Additionally if you are eligible for Medicare or are a claimed dependent on someone else’s taxes you can not open an HSA. On the other hand FSAs have to be set up by your employer, which automatically excludes self-employed or unemployed people. Your employer does have some qualifications they have to meet to be able to offer FSAs. For example they can only contribute to employee FSAs if they own less than 2% of the company. However, if they already offer these plans then there’s no other eligibility requirement on your end, all employees are eligible even ones without health insurance plans.
Annual contribution limits
Since contributions to these accounts are tax free they lower your taxable income. Because of this the IRS has placed limits on these plans. For FSAs the contribution limit is $3,050 as of 2023. For HSAs it’s $3,850 for individual plans and $7,750 for family plans.
Rollover rules
One of the biggest advantages of an HSA is that your funds roll over, meaning there are no time restrictions on using your funds. Since the account belongs to you, you get to decide when and how to use the funds. However for FSAs it’s not as simple. Unused funds are not automatically carried over into the new year. Since your employer owns the plan they decide what happens to the funds. Employers have 3 choices when it comes to rolling funds over:
Forfeiture – This means any unused funds will not roll over. Instead, they will be transferred to the employer.
Grace period – This is a 2 ½ month period after the plan year ends to use the last of the fund in the account, after this time frame, the funds then go to your employer.
Carryover- This allows employees to take $500 of the unused money over to the new year’s plan. Any funds left in the account after the $500 is carried over goes to the employer.
Changing contribution amounts
This is another point where HSAs are simple. You can contribute any amount you want at any time, you don’t have to keep the same contribution every time. Whereas with FSAs your contribution amount stays the same through the year. You can only change your contribution amount 3 times. First at open enrollment, when the plan renews you can decide to change your contribution amount for the new year. Next is if there is a change to your family situation such as a marriage, death, or birth you will be allowed to adjust the amount. Lastly, if you change employers when you enroll in your new employer’s health plan, assuming they offer one, you can select your new contribution amount since it’s an entirely new FSA.
Keeping your account when changing jobs
Unlike FSAs, HSAs follow you no matter how many times you change jobs because your account belongs to you. With FSA’s, they belong to your employer so unless you qualify for COBRA, you will no longer have access to your FSA if you leave your job.
Which Is Better?
If you qualify, the higher contribution limits and contribution rollover of HSAs make it the better option overall. HSAs are more flexible than FSAs, allowing you to save money over time for potential medical expenses. However, unless your job allows you to roll over $500 annually, your FSA balance will not build up over time. Depending on your employer’s decisions, unused funds are generally forfeited to your employer at the end of this year, meaning if you didn’t have many medical expenses for that year you could be losing money.
However, most of the time choosing between them is more dependent on your situation rather than which one you actually prefer to have. This is because the decision will depend if your employer even offers an FSA and whether or not your health insurance plan is an HDHP.
Getting Help With EZ
Both of these options can be excellent tax-free ways to save, invest, and pay for medical expenses, and EZ can help if you’re interested in HSAs. If you choose an HDHP, open an HSA as soon as you are eligible and begin contributing. Since these accounts continue to be one of the most effective ways to reduce expenses and improve your overall financial standing. To begin saving immediately, enter your zip code in the box below to receive free instant quotes. Or, contact one of our licensed agents at 877-670-3557.
If you’ve missed the health insurance Open Enrollment Period (OEP), or if you have had a sudden lapse in your insurance coverage, you might be stressing over how to get covered. But don’t worry, you still have options! One of your best options will be a short-term health insurance plan. These plans tend to be less expensive than traditional health insurance because they provide very limited coverage, and so they are usually meant as a stopgap for generally healthy people. So, what do these plans cover (and what don’t they cover), and what are the specific rules surrounding them?
Compared to traditional health insurance plans, which typically include a comprehensive range of benefits, short-term health insurance plans offer significantly less coverage. In fact, they are not required to provide coverage for the “10 essential health benefits” that traditional ACA-approved plans are required to cover.
That means short term health plans are not required to provide coverage for:
Pre-existing conditions
Medications
Maternity care
Mental health
Substance abuse treatment
But, with that being said, short term health plans are better than nothing, and generally provide coverage for:
What you can expect to pay for a short-term health plan will be determined by the specific plan that you choose, as it would be with any other type of insurance. You will be responsible for paying a monthly premium, in addition to:
Deductibles – As with other types of insurance, with a short-term plan, you pay for services out-of-pocket until your deductible is met. After that, your plan will start to split costs. Short-term health plans can have deductibles that are much higher than those of other, more traditional health plans.
Coinsurance – After you’ve met your deductible, your plan will cover your medical expenses in part, but you will also have to pay a percentage, known as coinsurance. For example, you might have to pay 30% of each covered medical expense, while your plan covers 70%.
Copays – This is a set fee that you may have to pay when you use a medical service. For example, you might have to pay $20 at the point of service when you go to the doctor.
Other expenses – If there are health care services that your short-term plan doesn’t cover, you might have to pay for them completely out-of-pocket. For instance, some short-term plans might not cover or only cover a certain amount of maternity care, mental health or substance use services, vision care, or dental care. If you need these services, you’d have to pay for them yourself.
One good thing about the costs of these plans is that their monthly premiums are typically much more affordable than the premiums for plans offered under the Affordable Care Act (ACA). With that being said, the reason that they are sold at a lower price is because most of the time, these plans don’t cover much, and only a portion of the monthly premium actually winds up being applied toward the cost of actual medical care.
Short Term Plans State-by-State
When it comes to the rules surrounding short term plans, every state is different. In fact, some states don’t even allow residents to buy these plans, but most allow a limited length of time to have one of these plans.
The following states allow you to have coverage with a short-term plan for 364 days, and allow you to renew up to 3 times for a total of 3 years of short-term coverage:
For more in-depth information on your state’s laws surrounding short term insurance, check out our state-by-state guides to health insurance.
Pros and Cons of Short-Term Plans
Short term plans can give you a number of advantages. But you should be aware that there are some drawbacks to this option as well. Knowing both the pros and cons of these plans will help you make an educated decision.
Pros
Affordability – The low price of these plans’ premiums is a highly attractive benefit.
Quick coverage – Plans usually go into effect within 7-14 days of enrolling.
Easy Cancellation – It is possible to terminate short-term insurance plans with little advance notice, particularly if you pay for your plan on a month-to-month basis.
Cons
Renewal Limitations – Short term plans do not automatically renew, and the number of times you are allowed to renew them is usually capped.
Coverage Limitations – In most cases, a temporary health insurance plan will not include coverage for all ten essential health benefits.
Availability Limitations – Not all states or insurance companies offer short-term plans to their customers.
Qualifying for Short Term Health Insurance
As discussed above, the majority of states permit short-term health plans, but there are a few that do not, and others that place restrictions on how long coverage can be maintained.
But even if your state permits short-term plans, you may still be denied coverage by an insurance company for health reasons. For example, you might be denied a short-term plan if you have a serious preexisting medical condition, or if you’re currently expecting a child.
In general, you will qualify for short term plans if you:
Are young and healthy.
Missed the OEP, and don’t qualify for a Special Enrollment Period
Are out of work and can’t afford COBRA or an ACA plan and need coverage in the meantime.
Are almost eligible for Medicare but do not want to enroll in a full year-long plan.
If you have a pre-existing condition, such as asthma or diabetes, you might want to steer clear of short-term plans even if you can get approved, because your premiums will be significantly more expensive, since these plans are not subject to ACA rules on preexisting conditions.
How to Buy Short Term Plans
Although you may be able to enroll in a short-term plan in person in some circumstances, the most common method for purchasing short-term health insurance is doing so online. You can also contact an insurance company that specializes in selling short-term plans directly.
Because of the state regulations surrounding short term health plans, and because these plans are offered by both national and regional companies, their availability is highly dependent on the state you live in. National companies sell short term health plans in multiple states, and regional companies have more localized service areas, so you’ll need to shop around. Speak to an EZ agent about what companies in your area offer the best short-term health plans.
FAQs
Will my doctor accept short term health insurance?
It depends on the plan. Some plans require you to stay in their network of doctors, with other plans, you can choose your own doctor and hospital without being subject to any restrictions. With that being said, in this case, there may still be financial incentives for using in-network providers.
Are pre-existing conditions covered?
When you apply for a short-term health plan, you’ll have to answer a short list of questions about your health, including about preexisting conditions. There’s a chance you will be denied coverage if you have certain preexisting conditions, and even if you are considered eligible for coverage, your plan will most likely not provide coverage for treatment of your preexisting condition.
So, when applying for one of these plans, examine the policy’s wording thoroughly. It’s common practice for short-term plans to use post-claims underwriting, which means that they’ll take your word for it about your health when you sign up, but can check your records after you’ve filed a claim to make sure you weren’t lying about any preexisting conditions.
Is losing my short-term coverage considered a qualifying life event?
Since short term health plans are not ACA-approved plans that provide minimum essential coverage, losing such a policy does not warrant a Special Enrollment Period that will allow you to shop for an ACA-compliant plan outside of Open Enrollment.
So, is a Short Term Plan the Best Option?
The purpose of short-term health plans is to provide healthy people with temporary, limited protection. Therefore, those who have ongoing medical needs or who have a history of illness should avoid short term health plans. If you’ve lost your coverage, and are in-between plans and looking to cut costs, short term health coverage is the way to go. But before you make a purchase, you should think carefully about whether or not it will meet your needs.
You can get information on short term health plans by contacting EZ.Insure and speaking with a licensed agent. We’ll go over all the details with you and help you figure out if one of these plans is right for you. And if it turns out a short-term health plan isn’t the best option for you, we’ll find you something that fits your budget and your health status. Get an instant quote by entering your zip code in the box below, or to speak to an agent directly, call 877-670-3557.
Oral hygiene is actually considered preventative care, just like annual physicals and routine blood work. If you take good care of your teeth and gums, you can stop dental health problems like cavities, gum disease, and even bad breath. Not to mention it helps stop other health issues as well. Oral health is also related to your entire body’s health. For example, if you have an infection in your mouth, the bacteria can actually travel through your bloodstream to other parts of your body. This bacteria can lead to heart disease and strokes. So, taking care of your mouth is an important part of staying healthy in general. Below we’ll look closer at how healthy mouths mean healthy bodies, as well as tips on how to take care of your teeth between dentist visits.
A cost-sharing reduction is a discount that reduces your deductibles, copayments, and coinsurance. They help reduce your out-of-pocket health care costs. Individuals qualify for health insurance coverage through the 
