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Published on January 11, 2017

7 Things to Know About Your Health Care Plan

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Enrollment Assistance and Education

You may qualify for FREE Medi-Cal or financial assistance to purchase private health insurance. Attend a free event, January 14th at Goleta Valley Cottage Hospital and have your questions answered. Call to 1-888-999-8262 make appointment.

Health care coverage seems to be in the news almost every day. Yet many people don’t realize that every medical plan is different, and they are confused when it comes to deductibles, co-pays and out-of-pocket expenses. Now that it’s a new year, it’s important to keep in mind a few key points so no unexpected medical bills surprise you.

Before any treatment, understand the total out-of-pocket cost to you

Add in the amount beyond your monthly premiums and verify your deductible, copay and co-insurance amounts. Review how much your plan covers for the medical services you need. Also verify your potential maximum out-of-pocket amount, which is the most you would potentially have to pay in any plan year apart from your premium.

Stay in your plan’s network

Health insurance plans usually cover a greater amount when a doctor or hospital is part of the plan’s network. So going outside of network can result in higher out-of-pocket costs. Contact your plan for a list of participating providers.

Does your plan require a pre-authorization?

When it comes to elective or non-urgent procedures, verify if your plan requires prior-authorization and that your provider has secured the proper authorization. Otherwise, your plan may refuse to pay some or even any of the services, leaving you with an unexpected bill.

The deductible on most plans resets by calendar year -- every January.

Many people are puzzled when they get a medical bill that they thought insurance would cover. For example, say you started a new job with new medical insurance last summer and paid enough out-of-pocket expenses to cover the deductible before the end of the year.

Come January, you need additional medical care and receive a bill that you thought your insurance would cover, but it didn’t. That’s because most insurance plans reset by calendar year, and you must pay your total deductible amount before most coverage begins again.

Keep in mind that some plans have separate deductibles for certain services, like prescription drugs. Also, family plans often have both an individual deductible, which applies to each person, and a family deductible, which applies to all family members.

You may be entitled to some freebies!

Unlike the deductibles for auto insurance and homeowners insurance, many medical plans cover certain preventative health services at no cost to you, and with some plans there’s no deductible required for these. Check your plan to see what preventative services it covers.

After you pay your deductible, you usually only pay a copayment for covered services.

However, sometimes with some plans, there can also be a co-insurance amount that will be an additional out-of-pocket expense. Check your plan to know for sure.

Open a health savings account, if available.

Many health plans offer the option for a Health Savings Account (HSA), which allows you to deposit pretax earnings to spend on health care. Any money and interest earned that isn’t spent that year simply remains in the HSA year after year. Some employers kick in dollars too, so check with your plan and your employer to see if this is available to you.

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Maria Zate, Manager of Public Relations

Phone: 805-879-8986

Email: mzate@sbch.org