out of pocket costs Archives

Questions To Ask Your Medicare Agent

When it is time to enroll in Medicare, change your Medicare plan, or purchase a Medicare Supplement Plan, speaking to an agent is a great idea. But before you do, make sure you have all of your information ready and available; you should also have an understanding of exactly what your needs are and what you’re looking for so your Medicare agent can better assist you. Because the details that you give an agent will determine which plan is right for you, EZ has provided you with what information you should have prepared, as well as what questions to consider asking one of our Medicare agents.

What You Will Need

medicare insurance card — *Be prepared with your Medicare Insurance Card, a list of health conditions, and your budget.*

Before speaking to your agent, be prepared to provide the following information:

Personal information- Your agent will ask you what zip code you live in so that they can research and compare plans in your area.
Health conditions– Prepare a list of all your health conditions, concerns, and/or medical records. Providing an agent with your specific healthcare needs can help them decide what plans might be best for you, since each Medicare Supplement Plan provides different coverage options.
Your Medicare Card– You will need to provide your agent with your card number so they can verify coverage.
Your budget- If you live on a fixed income, or have a specific budget in mind, have that information ready so you can discuss it with your agent.

Questions To Ask

There are different Medicare plan routes that you can take. When enrolling in Medicare, you have the option to enroll in a Medicare Supplement Plan at the same time. There are 10 different plans to choose from that offer different coverage options at different price points. Here are some questions to ask your agent if you’re considering a Medicare Supplement Plan:

Popular plans– Premiums can sometimes be lower for policies that are more popular, because more people are enrolled in those plans. Ask your agent which plans are the most popular in your area so you can compare their costs and benefits with those of other plans.
Waiting Periods– If you enroll in Medicare when you first turn 65, and you enroll into a Medicare Supplement Plan at the same time, then you have guaranteed issue rights. This means that you won’t have to pay extra for any pre-existing health conditions. It also protects you from having to go through a waiting period. But if you are enrolling in a Medicare Supplement Plan outside of your Initial Enrollment Period, then there might be a waiting period while you undergo the Medicare underwriting process, and you may have to pay more because of pre-existing conditions.
Using EZ’s Medicare agent will save you time, money, while providing you with a quality Medicare plan for your needs.
When Medicare Supplement Plan Coverage Begins- When you buy your Medicare Supplement Plan determines when coverage will begin for the plan. Ask your agent for a timeline, so you are aware of when you can start using your plan.
Out-of-Pocket Costs– This is a very important question to ask, especially if you are living on a fixed income. Ask about the out-of-pocket costs you are responsible for so that you can prepare for what your medical costs could be for the year.

Why Use An EZ Medicare Agent

When signing up for Medicare or a Medicare Supplement Plan, you need to have the right agent by your side. EZ.Insure will offer you an agent who cares, listens, and truly has your best interest at heart. What sets us aside from other companies is that our services are completely free. Our main goal is to help you, so our trained licensed agent will do all the work for you and compare all plans to find you the best plan at the best price. We are ready to answer all of your questions and get you covered. To get started, simply enter your zip code in the bar above, or to speak to an agent call 888-753-7207.

Out-of-Pocket Maximum Explained

Medical bills can be a huge source of stress. They can seem like they are never ending, but there is actually a limit on how much you can spend on out-of-pocket healthcare costs. The out-of-pocket maximum, which is the annual limit that you are required to pay for covered health services, is your financial saving grace. Each health insurance plan has different out-of-pocket maximums. Understanding yours will help you get a better handle on how much you will be paying out-of-pocket with your policy.

What Is an Out-of-Pocket Maximum?

An out-of-pocket maximum is the amount that you will have to pay for covered health services. Once you reach that amount, your insurance will pay for all covered services. All copayments, deductibles, and coinsurance count towards your out-of-pocket maximum. However, your monthly premium payments do not go towards your out-of-pocket maximum.

How It Works

If you need a medical procedure, generally you and your insurance company will each pay a portion of the cost. You will pay enough to meet your annual deductible, and your insurance company will pay for the rest of the procedure, unless you have to pay coinsurance as part of your policy. If your plan does require you to pay coinsurance then you will also have to pay 20% (usually) of the cost of the procedure, even after meeting your deductible.

After you have met your deductible, you will continue to pay copays and coinsurance until you meet your out-of-pocket maximum. After you meet your maximum, insurance will then pay 100% of any medical costs. You will not have to pay for copays or coinsurance after meeting your maximum.

calculator on paper with a pen sitting on top of it in the paper. — *After you have met your deductible, you will continue to pay copays and coinsurance until you meet your out-of-pocket maximum.*

Here’s an example to illustrate how out-of-pocket maximums work. Let’s say Mary has a health insurance plan with a $2,000 deductible, a 20% coinsurance requirement for all care after meeting the deductible, and a $5,000 out-of-pocket maximum. She has to have surgery and the total hospital bill is $20,000. The costs will break down like this:

Mary will pay her $2,000 deductible, leaving $18,000 of the bill.
Her coinsurance requirement is 20% of the $18,000, which is $5400. But because Mary’s plan has an out-of-pocket maximum, she and her insurance company will end up each paying part of this cost.
Mary has already paid $2,000 to meet her deductible, and her out-of-pocket maximum is $5,000 so instead of owing $5,400 in coinsurance payments, she only owes $3,000 ($2,000 deductible + $3,000 coinsurance = $5,000 maximum out-of-pocket payment).
Her insurance company will now cover the remaining $13,000 of the cost of the procedure.

Do All Plans Have a Maximum?

All plans that meet ACA standards have out-of-pocket maximums. For 2020, that number is $8,2000 for individuals and $16,400 for families. Some plans may have a lower maximum, but none will be higher than those amounts. Plans with higher monthly premiums generally have lower out-of-pocket maximums, while plans with lower monthly premium plans, like catastrophic or high-deductible health plans, have higher out-of-pocket maximums.

In order to find the right plan for your needs and budget, you have to take into account everything that it has to offer, including things like out-of-pocket maximums. Doing all the research alone is time-consuming and can cause confusion and missed opportunities. EZ will make the process quick and painless; we’ll explain everything clearly, give you real-world examples of how the plan would work for you, compare quotes, and calculate costs for you. We will set you up with one agent that will help you find the right plan for your medical and financial needs. To start saving, enter your zip code in the bar above, or to speak to one of our licensed agents, call 888-350-1890.

Out-Of-Pocket Costs Result In Fewer People Visiting Primary Doctors

The cost of health care continues to rise every year, making it harder for many people to afford their medical bills. Data collected over the years shows that doctor visits for people under 65 years of age have dropped over 25%. In the years 2008 to 2016, up to 46% of the adults went at least a year without visiting their primary care doctor. Why? Well due to the rising health care costs, people are opting out of going to see their primary care doctor.

The majority of people just cannot afford the out-of-pocket expenses that accompany a visit to the doctor. Costs for things such as copays or lab work can become prohibitively high for many people to afford. However, primary care is effective in prevention of disease, and going without seeing your doctor can exacerbate an existing health condition.

stacks of money in a silver suitcase. — *“There is a lot of data showing that when you raise health care costs, people will receive less care.”*

More Money, More Problems

When things go up in price, people tend to shy away from spending the extra money. This does not exclude health care costs. The more money people have to pay, the less likely they are going to go to seek medical attention.

“There is a lot of data showing that when you raise health care costs, people will receive less care,” Dr. Kimberly Rask, chief data officer at Alliant Health Solutions, wrote in an editorial accompanying the study. “But it doesn’t mean that they only stop unnecessary care. They will reduce both necessary and unnecessary care.”

“When patients have to pay more, they may pause, and they may not go in if they don’t think it’s that urgent,” says Nadereh Pourat, a professor of health policy and management at UCLA’s Fielding School of Public Health. But health problems can worsen, she adds. “You don’t want them to wait til things get really bad.”

The Benefits of Primary Doctor Visits

caucasian doctor checking a mans blood pressure. — *Going to your primary doctor has many health benefits. They keep your health on the right track and help manage conditions.*

A primary care doctor may be able to pick up on, and test for, an underlying problem that a person is unaware of. It can be harmful for people not to see their doctors at least one a year, especially if they have a chronic condition that needs to be managed, such as high blood pressure.

During your annual physical, your doctor will also go over your current medications. This is to determine whether they are working or whether changes need to be made to them. Doctors will also keep you from making the mistake of taking two medications together, which could cause a dangerous drug interaction.

“Primary care has all kinds of benefits,” says Dr. Ishani Ganguli, Harvard assistant professor of medicine and physician in general internal medicine and primary care at Brigham and Women’s Hospital. “Both for patients but also for populations,” Ganguli says. The research shows that people are more healthy when they see a primary care doctor for routine care. Where there are more primary care providers per capita, death rates drop for heart disease, cancer, stroke, and other illnesses. Not only do the death rates decrease, but life expectancy goes up.

Although health care costs are on the rise, it is still very important to visit your primary care doctor at least once a year. It is necessary to stay on top of your health, and live a longer life. At the very least, an annual visit will bring you peace of mind. In the most extreme cases, it could save your life.