Understanding Your Health Insurance Coverage

#1 Rule for Health Insurance Open Enrollment: Understand Your Coverage

We’re in the thick of open enrollment, the time of year to focus on renewing or selecting new healthcare (and prescription) insurance, plus making the most of our current insurance benefits. In both cases, the first rule is to understand exactly what your insurance covers.

Maximize your current coverage now

If you’ve met your deductible, the remainder of 2014 is an ideal time for elective procedures, surgeries, appointments, etc. that your current insurance covers. That is why this time of year is exceptionally busy period for healthcare providers. Also, don’t forget that your “well visit” is fully covered by Medicare (with no out-of-pocket expenses) and most other insurance, so make sure to take advantage of this once-a-year opportunity by calling your healthcare provider immediately.

Insurance selection tips

While it’s always nice to get a head start in October to compare your current coverage with other options, there’s still time to do some research. Insurance is somewhat of a gamble for you and your insurance provider. You’re paying a set amount up front, trying to “hedge your bets” that your plan that will provide all the coverage you need; but the insurance company is betting that you will need less coverage than you’re paying for.

It’s especially important to understand what Medicare does and does not cover. If you need certain services that aren’t 100% covered under Medicare Part A or Part B, you’ll most likely have to pay for part of them yourself unless you are enrolled in a:

  • Medi-gap (secondary) plan
  • Medicare Advantage plan
  • Medicare Part D Prescription Drug Plan

Keep in mind that:

  • Even if Medicare Part A or Part B covers a service or item, you generally have to pay deductibles, coinsurance, and copayments. In general Medicare covers 80% of the expense of a covered service – so you still have to pay the other 20% which can really add up!
  • Since Medicare Advantage plans do not necessarily provide coverage equal to Medicare, they may not be right for you if you require a surgery or procedure or have a condition (diabetes, urinary incontinence, etc.) that requires ongoing therapy, treatment with a prescription or supplies.medicare-logo-2 Before choosing any Advantage plan be sure to read all the exclusions in your contract. Don’t be blinded by advertisements offering $0 co-pays. If it sounds too good to be true – it probably is!

Coverage for urinary incontinence supplies

Medicare Part B covers services or supplies for diagnosing or treating medical conditions. The one-a-day gold standard in treating male urinary incontinence, Men’s Liberty external collection device, is covered. http://blog.mensliberty.com/get-Mens-Liberty

Absorbents (pads and adult diapers) are not covered by Medicare or most private insurances. Condom catheters are covered, but regular use can lead to infection and skin breakdown, often entailing additional medical treatment and hospitalization and greater cost to patients.

Take Action Now During Open Enrollment – and follow these simple guidelines to get the most out of your insurance coverage!

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