Understanding Your High Deductible Plan
What is a Deductible?
A deductible is a fixed dollar amount specified by your insurance plan that individuals must pay out-of-pocket before your health insurance begins to pay. In most cases, the deductible must be met each “plan year”, which is not necessarily the same as a calendar year.
What is the best way to find out about what is covered under my insurance plan?
There are many healthcare insurance companies, each offering several different plan options within their portfolio. Under the Health Insurance Portability and Accountability Act of 1996 (HIPAA), your Health Insurance company is unable to disclose your health plan information to a provider so we would encourage you to contact your plan benefits administrator to understand what services are covered.
How is a Traditional Deductible Health Plan different from a High Deductible Health Plan (HDHP)?
HIGH DEDUCTIBLE PLANS
Have a deductible of $500 or less
Have deductibles of $1,300 or higher
Have a copayment of $20 – $50 per office visit
New West Physicians assesses a $75 payment at the time of service for each office visit that will be applied toward your deductible.
Tend to have higher premium rates
Tend to have lower premium rates
Have a lower limit for out of pocket expenses for services and pharmaceuticals.
Have much higher limits for out of pocket expenses for services and pharmaceuticals.
Are preventative services covered by my insurance?
The Patient Protection and Affordable Care Act of 2010 mandates full coverage for preventative healthcare.
• Please be aware that what actually constitutes preventative health coverage will vary according to the insurance company and plan.
• Services such as laboratory or diagnostic testing may not necessarily be covered in full or at all by your insurance company.
• There may be a coinsurance or other amount that you are still responsible for paying.
• It is imperative to know and understand what your preventative wellness benefits are prior to seeing your healthcare provider.
If you would like to review other helpful tools, visit our Accepted Health Plans located on our Website.