The beginning of a new calendar year is an important time for medical insurance. Since several components of your coverage hinge around the calendar year, this is a great time to evaluate your coverage and make sure that you understand exactly how your benefits work.
Deductibles: The beginning of a new year often marks the re-setting of your medical deductibles. In plain English, you will probably have to pay a large chunk of your first medical bill or two for each member of your family. Check out your medical insurance plan’s details to determine exactly what your deductible is.
Maximum Out of Pocket Limits: Many medical plans have a cap on the amount an individual or family will be forced to pay in a year. Now, it’s a pretty hefty amount so you may never reach it. If your family reached that cap last year, you should be prepared to start making medical payments again.
Co-payments: Although your co-payment amount may not change with the new year, making sure that you understand how much you will pay for your medical services is still a good idea. Take a moment to look up your co-payment amounts so that you can be prepared for your next visit to the doctor’s office. Be sure to brush up on your prescription co-pays, too.
Network or Non-Network Providers: Like co-payments, there may not be a change to the list of doctors who are within your health insurance’s network at the beginning of a new year. However, there is certainly no harm in verifying that your doctor is still a member of your plan’s network. Doctors regularly come into and leave these types of networks, and they are not required to notify their patients of the change. The last thing you want is to be surprised with a bill for a non-network provider when you thought you were seeing a doctor in your network.
Deferrals to a Medical Reimbursement Account: If your employer allows you to defer a portion of your paycheck to a medical reimbursement account, your time could be running out to use up your remaining balance. Be sure to turn in receipts for your medical expenses to get your money’s worth. Any changes you would like to make to your deferral amount will probably need to be made at the first of the year, as well.
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I am having issues with my health insurance after having surgery from what they considered a pre-existing injury. what should I do?
Craig,
Sorry to hear you are having problems with the insurance. Did you get pre-authorization before the surgery was done? Otherwise, I think the only thing you can do is to follow the dispute process per your insurance company’s guidelines.
Health insurance co-pays used to lead to the biggest (unexpected) out of pocket expense for our family, and it was very frustrating, because they were upped without our changing benefits due to a company policy change. It was tough to even justify any trip to the doctor on our budget! However, now that we live overseas, the costs are much less expensive and they demonstrate exactly how overpriced medical care is in North America.
Jerry
I’m seriously considering moving to another country at retirement. If the predicted layoffs come (an increasingly likely scenario), the cost of COBRA ($475/month for one person) will make the cost of the co-pays unaffordable. For the co-pays alone, I’ll be paying 25% of the MAXIMUM net pay I could cobble together while taking early Social Security–assuming I actually can scrounge up 14 grand by freelancing and part-time teaching. When I reach Medicare age, the cost of Medicare (assuming it doesn’t rise significantly in the next year or so) will consume 16% of my net pay. In either event, the only time I could possibly justify seeing a doctor will be in a real emergency: heart attack, stroke, car wreck.
For me, unemployment will make health care inaccessible. I may be better off to sell my house and move to a country that provides reasonably decent health care to residents. I’m told even Mexico is now not significantly worse than the US if you’re affluent enough to afford Mexico’s version of Bond Street doctors. And in a third-world country, affluence is highly relative.