Health Insurance Articles
How To Find Out How Much Per Year Your Health Care Plan Will Pay Out For Medical Expenses
2010-03-12
In addition to providing access to front-line medical care and specialists, any decent HMO, PPO or self-directed health care plan will offer a specified amount of coverage for medical expenses each year. This amount covers everything from doctor and hospital visits to ongoing care, such as prescription drug purchases and treatment plans for recurring illnesses. This amount can vary widely, and can also be affected by how much you choose to pay for your deductible. The higher the amount you are willing to pay initially for treatment, the more your health insurance provider will be willing to pay, as their portion of the payment will occur less often. Your maximum coverage may also include a co-payment on every service in the network, regardless of deductible.
One of the most important things to know about any health insurance coverage is what the annual coverage maximum is. In order to find this, start by looking at your policy. On what is known as your "statement of benefits," there should be a listing for annual maximum coverage. If there is not, it is possible that your provider has no maximum cap, but do not just assume this is so if you cannot find it on the policy. Often, the caps will be hidden in the fine print, or it will be different based on where you go for treatment. Sometimes a health insurance quote will include two different annual maximums - one for in-network care and one for outside-network care.
Even if you can find the maximum amount listed, it is still a good idea to call your insurance company and confirm. In addition, ask if any remaining coverage can be carried over to the next year. Some companies offer this, which can help a healthy family save up for an unexpected large illness or injury. If the maximum amount seems too low, ask what can be done to raise it. This can often be as simple as a premium increase, but can also take the form of higher deductibles or greater co-payments. While many maximums seem high when written out or listed over the phone, ongoing medical treatments or even a few days in the hospital and one surgery can eat up an entire year's worth of coverage. Be sure to ask your provider what your options are if that occurs.
Although coverage maximums can make getting the treatment you need difficult, it is beneficial to know what they are so you can plan accordingly, and use your coverage only when necessary, or add to it if need be. Ideally, you want to make sure you have your maximum payout available should you really need it.
