Ghester
Insurance
Common Health Insurance Mistakes and How to Avoid Them
April 22, 2024
Tips for Making Informed Decisions and Avoiding Common Pitfalls
Navigating health insurance can be confusing, and many people make mistakes that can cost them time, money, and peace of mind. Here are some common health insurance mistakes and tips on how to avoid them.
Common Mistakes
Not Reviewing Your Plan Annually:
Many people stick with the same plan year after year without reviewing it. This can lead to paying for coverage you don’t need or missing out on better options.
Ignoring Preventive Care:
Many insurance plans cover preventive care services at no additional cost. Skipping these services can lead to undetected health issues and higher medical costs in the long run.
Choosing the Wrong Plan Type:
Selecting a plan with a low premium but high out-of-pocket costs can be a mistake if you require frequent medical care. Conversely, choosing a plan with high premiums but low out-of-pocket costs might be unnecessary if you are generally healthy.
Not Understanding the Network:
Choosing a plan without checking if your preferred doctors and hospitals are in-network can lead to higher out-of-pocket costs.
Overlooking Prescription Coverage:
Not all plans cover the same medications. Failing to check if your prescriptions are covered can result in unexpected expenses.
How to Avoid These Mistakes
Annual Plan Review:
Make it a habit to review your health insurance plan each year during open enrollment. Compare it with other available plans to ensure it still meets your needs.
Utilize Preventive Care:
Take advantage of free preventive care services such as vaccinations, screenings, and annual check-ups. This can help detect health issues early and keep you healthier in the long run.
Assess Your Health Needs:
Consider your medical history and anticipated health care needs when choosing a plan. If you expect frequent medical visits, a plan with higher premiums but lower out-of-pocket costs might be more cost-effective.
Check the Network:
Always verify that your preferred doctors, specialists, and hospitals are in-network before choosing a plan. This will help you avoid higher costs for out-of-network care.
Review Prescription Coverage:
Make a list of your medications and check if they are covered under the plan you are considering. This can prevent unexpected costs for non-covered drugs.
By being aware of these common mistakes and taking steps to avoid them, you can make more informed decisions about your health insurance and ensure you have the coverage you need.
As Medicare’s open enrollment approaches, it’s essential to stay informed about upcoming changes that could significantly impact your healthcare costs. At G Hester Insurance, we believe that being proactive during this period can lead to substantial savings and better coverage. One major update on the horizon is the implementation of drug price reductions through Medicare’s new negotiation power. Here’s a breakdown of key changes you need to know: 1. Significant Prescription Drug Price Reductions Under the Inflation Reduction Act, Medicare now has the authority to negotiate drug prices, leading to major price cuts for some of the most expensive medications. These reductions won't take effect until 2026, but they are expected to save Medicare enrollees approximately $1.5 billion in out-of-pocket costs. Here are some notable price drops: Eliquis: From $521 to $231 for a 30-day supply. Xarelto: Price reduction from $517 to $197. Januvia: Currently priced at $527, will drop to $113. Jardiance: From $573 down to $197. Enbrel: A rheumatoid arthritis medication, will decrease from $7,106 to $2,355. 2. Increased Focus on Preventative Services Medicare continues to expand coverage for preventative services, encouraging early detection and prevention of serious health conditions. From cancer screenings to wellness visits, these services may now be covered at no additional cost, depending on your plan. This means that staying healthy could become even more affordable. 3. Expanded Telehealth Coverage The pandemic has accelerated the use of telehealth, and Medicare has responded by expanding its coverage for these services. Whether you need a routine check-up or a consultation with a specialist, more providers are offering telehealth as an option, giving you flexibility and convenience in managing your healthcare from home. 4. Updates to Medicare Advantage Plans If you’re enrolled in a Medicare Advantage plan, be on the lookout for changes in your benefits. Some plans may offer additional perks such as transportation to medical appointments, gym memberships, and expanded dental or vision coverage. However, premiums and co-pays may also change, so it’s crucial to review your plan during open enrollment. 5. New Out-of-Pocket Maximums In 2026, there will be adjustments to the out-of-pocket maximum for Medicare Part D, the prescription drug coverage plan. This could affect how much you pay for your medications in the long term, so understanding these changes is essential when reviewing your Part D coverage options. By staying informed about these changes and reviewing your plan during open enrollment, you can ensure you’re making the best decisions for your healthcare and budget. Schedule a Consultation At G Hester Insurance, we're here to help you navigate these changes. Contact us today to schedule a consultation and discuss how these updates may affect you. Together, we’ll ensure you’re prepared for the upcoming enrollment period.
Health insurance is a critical part of managing your health and finances, but many people overlook the importance of reviewing their plan annually. Just like you visit your doctor for a regular check-up, your health insurance plan also needs an annual review to ensure it still meets your needs and budget. Here’s why it’s important and how to do it effectively.
Health insurance terminology can be confusing, but understanding the basics can help you make better decisions about your coverage. Here’s a breakdown of deductibles, co-pays, and coinsurance, and how they impact your out-of-pocket costs. Deductibles A deductible is the amount you pay out-of-pocket for covered health care services before your insurance plan starts to pay. For example, if your plan has a $1,000 deductible, you will need to pay the first $1,000 of your medical bills before your insurance kicks in. Example: If you have a deductible of $1,000 and incur $1,500 in medical expenses, you will pay the first $1,000, and your insurance will cover a portion of the remaining $500, depending on your plan’s coinsurance. Co-Pays A co-pay (or copayment) is a fixed amount you pay for a specific service or prescription. Co-pays are usually required at the time of service and can vary depending on the type of care you receive. Example: If your plan has a $20 co-pay for doctor visits, you will pay $20 each time you see your doctor, regardless of the total cost of the visit. Coinsurance Coinsurance is the percentage of costs you pay for covered services after you’ve met your deductible. Unlike co-pays, which are fixed amounts, coinsurance is a percentage of the total cost of the service. Example: If your plan has 20% coinsurance and you have already met your deductible, you will pay 20% of the cost of covered services, and your insurance will pay the remaining 80%. Out-of-Pocket Maximum The out-of-pocket maximum is the most you will have to pay for covered services in a plan year. Once you reach this limit, your insurance plan covers 100% of the costs for covered benefits. Example: If your out-of-pocket maximum is $5,000, once you have paid $5,000 in deductibles, co-pays, and coinsurance, your insurance will cover all additional covered medical expenses for the remainder of the plan year. Putting It All Together Understanding how deductibles, co-pays, and coinsurance work together can help you estimate your potential out-of-pocket costs and choose a plan that fits your budget and health needs. For instance, if you expect to need a lot of medical care, a plan with a higher premium but lower deductible and out-of-pocket maximum might save you money in the long run. By familiarizing yourself with these key terms and how they affect your costs, you can make more informed decisions about your health insurance and avoid unexpected expenses. If you have any questions or need help choosing the right plan, contact Ghester Insurance for expert guidance.