Is Your Health Insurance Plan Changing in the New Year?

New Year, New Plan?

As we approach the New Year, we also enter into the season of open enrollment.  Health insurance plans change and deductibles reset during this time. Understanding these changes can be frustrating and confusing without knowledge of health insurance.

Important Terms

A deductible is the dollar amount that needs to be met before your health insurance will begin to pay claims. If your deductible for the year is $1000, you must pay up to $1000 before the insurance begins to pay. Co-insurance is the cost share percentage that puts a certain amount in your responsibility.   If the insurance covers 80% of the claim and the charge is $100, $20 will be your responsibility.

Medicare Advantage Plans

Health insurance plan

There can be a great deal of confusion when patients switch to a Medicare Advantage plan.  A Medicare Advantage plan is sponsored by a private insurer (e.g.; Aetna, Blue Cross) which replaces Medicare as your primary insurance. Medicare advantage policies often carry lower premiums which are offset by higher out of pocket costs. You can expect to pay less in monthly premiums but more when you utilize health care services.

Notification of Health Insurance Changes

Unions and employers often make changes at the beginning of each calendar year. Recently, the state of New Jersey announced changes for public workers and retirees (health benefits changing).  While most employers provide ample notice of a change, often retirees are left to rely on letters mailed home from the insurance carrier.

What Can You Do?

If you feel your insurance has changed or will be changing, it is important to confirm that your current physicians are participating with your new plan. Some health insurance plans carry out of network benefits.  In these cases, benefits are paid at a rate that may have a higher out of pocket costs than providers in the network.

Most importantly, if your insurance has changed and you have questions or concerns, regarding physical therapy or any of aspect of your benefits, we are here to help you.  If you receive a new insurance card in the mail, even if the card looks similar or the same, present it to our front office professionals so they can update your record.