The world has changed in ways we never could have anticipated a year ago. As we approach the holiday season and take time to reflect on how far we’ve come and where we intend to go, it’s pertinent for us to also examine medical needs and how to protect ourselves for the future.
One of the biggest questions surrounding healthcare this year is how to protect yourself from excessive medical costs that could result from a COVID-19 related hospital stay. Without health insurance, a hospital stay could result in a significant unexpected expense. This is especially alarming considering the increase in COVID-19 related hospitalizations and the fact general medical expenses are on the rise. With around 65% of all bankruptcies being related to medical debt, it’s more important now to make sure your medical costs are covered.
Both Medicare Advantage plans and Affordable Care Act compliant individual and family plans offer a financial safety net called an Out-of-Pocket-Maximum. Also referred to as a Maximum-Out-of-Pocket or MOOP, these benchmarks represent the hard limit on what you’ll pay for medical care in a given year. Should you have a catastrophic year the MOOP will be the accumulation of any medical deductible, co-pay and coinsurance that you have paid. After you reach it your insurance company will pay 100% of your medical costs for the rest of the calendar year. You will need to speak with your experienced insurance broker regarding the Out-of- Pocket-Maximum specific to your plan.
While it’s estimated that less than 5% of people actually hit their Maximum-Out-of-Pocket in a given year, the MOOP still serves to provide peace of mind for life’s unexpected twists and turns.
As an example, let’s say, Cathy, who has chronic asthma, is diagnosed with COVID-19 and is experiencing trouble breathing. Her husband Chuck takes her to the emergency room where she is immediately placed on oxygen and undergoes a series of tests and diagnostic radiology to confirm her limited lung function. Cathy spends three days in the Intensive Care Unit and another two days in a private room under observation. After she is released from the hospital, Cathy needs to see doctors several times a month to monitor her condition and ensure she’s recovering well. These visits often include a number of tests and imaging to ensure her lungs are regaining strength. Awhile later, Cathy is finally starting to regain her strength when a bill arrives in the mail for what could be more than double the cost of her house!
As Chuck and Cathy look over the itemized list of services, they are stunned to see that all of Cathy’s tests, medications, and doctor fees are cumulated in a bill that could require their life savings to pay. Without insurance, Chuck and Cathy would have to consider dipping into retirement savings, delaying retirement altogether, or even selling their house to finance the expenses.
Cathy and Chuck are hypothetical representations of situations that happen all too often. Thankfully, all Medicare Advantage and Affordable Care Act compliant plans have an Out-of-Pocket- Maximum. Many insurance companies are also waving testing and treatment costs for COVID-19! Although the specific amounts will vary from plan to plan, you can still use online tools to see your options. For Medicare Advantage plans, you can call Your Insurance Gal Agency for a link that allows you to compare Medicare plans that are available in your county in an easy to use side-by-side format. If you’re under 65, you can use the health insurance marketplace to look at plans in your service area. If you’re in Washington, these plans are available through the Washington Health Plan Finder at WAHealthPlanFinder.org.
Although plan information is at your fingertips the excess of information can be tough to wade through. With almost 40 Medicare Advantage plans and over 50 individual and family plans available in Clark county, it’s definitely worth your time to consult a local broker for guidance. If you need help understanding what benefits your coverage offers or if you want to see what other options you have, reach out to a local broker like Stacey Johnson and her team of agents at Your Insurance Gal Agency. They’ll take the time to learn about you and your needs and help you understand your options.
We can all agree that 2020 has brought about a lot of changes. Make sure you contact an experienced broker to ensure that you are covered in a manner that is best for you and your unique situation. In uncertain times, the greatest gift you can give yourself is peace of mind through a comprehensive insurance plan and a local independent broker who can make the process a breeze!