The amounts you pay for prescription drugs covered by your plan would count towards your out-of-pocket maximum. If you purchase a prescription that is not covered by your plan for whatever reason (it’s not on the plan’s formulary, it’s considered experimental, etc.), it would not count.
Not all health plans include prescription coverage, so you may be interested in a stand-alone prescription plan which is available for individual purchase. These plans have a separate…
Deductibles, co-insurance, and co-payments are different ways that you and your plan share the cost when you receive medical care. Learn more. The specifics of each of these cost sharing methods varies from plan to plan, but the following gives a general overview of how they work. See your plan document for specific information.
You pay a deductible each year (or policy period)
With your car or house insurance, when you have a claim you pay the first few (or several…
The out-of-pocket maximum is a limit on what you pay out on top of your premiums during a policy period for deductibles, coinsurance and copays. Once you reach your out-of-pocket maximum, your health insurance will pay for 100% of most covered health benefits for the rest of that policy period. The next policy period (plan year), it starts all over again - note: the policy year may not coincide with the calendar year.
Thinking ahead about the health care services that you may need in the…
An Explanation of Benefits (EOB) is a statement that your insurance company sends that summarizes the costs of health care services you received. An EOB shows how much your health care provider is charging your insurance company and how much you may be responsible for paying. This is not a bill. If you owe money, you will receive a separate bill from your health care provider. Individual EOBs are likely to differ from the example provided.
Depicted in EOB statement example above, are these…
A premium is the amount you pay for health insurance every month. Just like your car or home insurance, it’s the amount you pay to the insurance company so that you’re covered―whether you use it or not.
If you receive healthcare coverage through your work, your employer may pay a percentage of your premium, with the rest being deducted from your paycheck (you can review your pay stub or contact your employer for more information).
Premiums can vary quite a bit depending on the details of your…
Balance billing occurs when your out-of-network healthcare provider bills you for the difference between their charges for the service you received and the amount your insurance plan has established as the allowed amount. If your health insurance coverage does not include out of network services, you will be billed for the entire provider charge.
Your doctor charges $6,000 for a surgical procedure. Based on the negotiated contract between your insurance company and the doctor, the…
There are several types of accounts available to help you save on your taxes and manage your medical costs.
Health Savings Account (HSA)
You don’t need to have health coverage through an employer to set up and contribute to an HSA, but you do need to be enrolled in a high deductible health plan that meets Internal Revenue Service (IRS) requirements. For calendar year 2019 the annual limitation for deductible for an individual is $3,500 and for a family is $7,000.. There are other…
There are a number of ways to make your prescriptions more affordable, depending on your situation and the medications you need.
Ask your doctor or pharmacist if a generic version is available. Generic drugs are typically less expensive than brand-name drugs. Learn more.
Consider getting your prescriptions through a mail-order pharmacy. Learn more.
Look for coupons on the internet by searching for the drug name and financial assistance. You may find coupons on the…
Billing mistakes can happen. If the amount on your Explanation of Benefits (EOB) doesn't match the bill from your healthcare provider, take the following steps :
Collect all of the paperwork. Sometimes more than one EOB applies to a single bill.
Compare the codes/descriptions of services from your EOB and your medical bill and make sure that they match and look for duplicate charges.
Review the services to make sure that only services that you received are listed, and that the amount you owe…
If your claim is denied, start with a few basic questions:
Was your insurance coverage in effect at the time of the service?
Was the healthcare service a covered benefit? Was it medically necessary? Learn more.
Was the care provided by an in-network provider?
Were all necessary referrals or preauthorization from your insurance company in place? Learn more.
If you think the services should have been paid, you may want to ask your insurance plan to reconsider. If that doesn’t work, your next…
An Explanation of Benefits (EOB) is a statement that your insurance company sends that summarizes the costs of the health care services you received. This is not a bill. An EOB shows how much your health care provider is charging your insurance company and how much you may be responsible for paying. Closely review your EOB to make sure that it includes only services that you received and that the amount you owe is consistent with your health insurance benefits.
If there are services on your…
Most of the time, you will pay something when you receive medical care. When you and you insurance company each pay part of the cost, it is known as “Cost Sharing”. There are a number of different types of cost sharing, and sometimes you’ll pay more than one for a particular service:
The deductible is the amount you will pay each year (or policy period) for most health care services before your insurance company begins to share the costs.
For example, if your deductible is $500,…
There are a number of organizations in New Hampshire that can help you get health care regardless of your ability to pay, or help you find a health plan that is affordable. Get started by visiting the links below:
Community health centers and low-cost care:
Help paying for prescriptions:
Children’s medical assistance information:
Each insurance company negotiates discounted rates
Health insurance companies rarely pay the full charge for a service; instead, they negotiate the price they will pay for health care services ahead of time. Each insurance company negotiates with health care providers to establish the discounted prices that their members will pay to receive care and services.
So, when you’re choosing a plan you may want to use the Health Costs section of this site to do some comparisons of sample services to…