There are associated costs when enrolling in a health insurance plan. These costs include premiums, coinsurance, and deductibles. The deductible is what we will concentrate on in this article. Your deductible is the amount you pay out-of-pocket before your health insurance starts to pay your covered medical services for the remainder of the year. By “remainder of the year”, we mean that your deductible renews annually. Therefore, it’s important to understand how to meet the deductible before it renews and what happens after you’ve met it.
What Counts Towards Your Deductible
Not knowing which expenses count toward your deductible could lead you to throwing money away. There are 3 basic things to remember if you want to know what payments count towards it. Any out-of-pocket payment that is:
Medically necessary
For a service covered by your plan
Within your network
To simplify further, the following are some of the medical services you pay that would count towards your deductible:
Hospital bills
Surgery costs
Lab tests
MRIs and CAT scans
Anesthesia
Doctor visits not covered by copays
Medical devices such as pacemakers
To give you a real-world example, if you have to have a procedure, you must first pay your deductible before the insurance company will cover the remaining costs. Say the surgery costs $25,000 and your deductible is $2,000. You will pay $2,000 and then the insurance company will pay the remaining $23,000.
What Doesn’t Count Towards Your Deductible
It’s just as important to know which expenses don’t go towards your deductible. This way if you’re keeping track (which you should be) you won’t think you’ve paid more towards your deductible than you actually have.
A copay is the portion of your medical expense that you are responsible for usually at the time of service. Typically copays are a modest, set amount. For example, you may have a $25 copay every time you visit your primary care physician (PCP). Or you may have to pay $15 every time you fill a prescription. The amount for each service varies depending on your insurance company and plan. Unfortunately these payments don’t count towards your deductible. They do however count towards your out-of-pocket maximum, which is the max amount of money you have to spend on your healthcare in a single benefit year under your plan.
Coinsurance
Your coinsurance is another cost-sharing part of your health plan. This is usually shown as a percentage and shows exactly the percent you have to pay and the percent your insurance has to pay after you have met your deductible for the year. For example if you have a 20% coinsurance for a covered service, your insurance company will pay the other 80%. Say you’ve already met your deductible and you need a procedure that costs $1200,with your 20% you pay $240 and your health insurance will pay the remaining $960. Just like with copays, your coinsurance won’t count towards the deductible, but it does count towards your out-of-pocket maximum.
Premium
Your premium, as you know, is the amount you pay monthly to keep your health insurance policy active. While your premium and deductible do have a significant relationship, since the lower your premium the higher your deductible and vice versa, it still doesn’t count towards your deductible. Your premium will also not count towards your out of pocket maximum either.
Out-of-network care
Out-of-network care means you went to a provider that is not contracted with your health insurance plan. None of your costs with this provider will go towards your deductible or your out of pocket maximum. The only exception to this rule is if you have a health plan that does have out-of-network coverage such as a Preferred Provider Organization (PPO). A PPO has 2 out of pocket maximums, one that works like every other plans maximum and one specifically for out-of-network services.
Services not covered by your plan
If you get care that your plan does not cover it won’t count towards deductibles or out of pocket maximums either. This can include things like chiropractors, acupuncture, dental, and vision services.
Family Plan Deductible
Deductibles work differently for individual plans than they do for family plans. A family deductible is the maximum amount that a family must pay out-of-pocket before they start paying coinsurance or copays, rather than the full cost of services. Most family health insurance policies have 2 deductibles. The first being each individual member has their own individual deductible and the second is the overall family deductible. Each time a family member pays towards their own deductible the amount is also credited to the family deductible. If one member meets their individual deductible before the others, then full coverage begins for that person alone, but not for the other family members.
Once the family deductible is met then everyone will receive post-deductible coverage even if not all members met their individual deductible. Family plan deductibles are typically double the amount of an individual plan’s deductible. Although deductibles can vary, it’s uncommon for a family to pay more than the cost of 2 individual deductibles in a single year. This obviously doesn’t apply if each family member has separate policies, as the policies will not coordinate together.
High Deductible Health Plans (HDHP)
Whether you have a family plan or an individual plan you have an option with your deductible. A HDHP is not just a plan that appears to have a high deductible, it is a distinct type of health insurance – not just a generic term. A high-deductible health plan is a health insurance policy with a deductible of at least $1,400 for individual coverage or $2,800 for family coverage. These plans also allow you to make contributions to a tax-advantaged Health Savings Account that can help you save money towards your health care. A policy with a high health insurance deductible will save you money on premiums, but you may be responsible for out-of-pocket expenses of up to $8,700 for individual coverage and $17,400 for family coverage.
In recent years, HDHPs have become increasingly popular. This is because they come with lower premiums. However, even though your monthly premium is lower your out-of-pocket medical expenses tend to be a lot more expensive than someone with a LDHP. Low deductible plans come with a higher premium, but medical expenses are lower. If you expect to have very few medical expenses then a HDHP might be right for you. This is because the low premiums combined with a deductible you rarely use may save you more money. LDHP are best for people with chronic conditions or families who expect to have multiple doctor visits per year. This reduces your upfront costs allowing you to manage your expenses easier.
Once You Meet Your Deductible
After you’ve met your annual deductible, your insurance will begin paying its portion of the cost of your covered care for the remainder of the year. After meeting it, your portion of the cost of care will either be a copayment or coinsurance. It’s important to note that any health insurance plans purchased on the Marketplace legally have to cover the cost of some preventative healthcare services even before you meet your deductible. This is for any plan regardless of type or tier. Some of these preventative benefits include:
HIV screening
Blood pressure screenings
Obesity screenings and counseling
Lung cancer screenings
Fall prevention
Tobacco use screenings
FAQs
When does my deductible renew?
Many health insurance plans base their renewal on the calendar year. This means that on January 1st of each year any expenses you have paid towards it are zeroed out. Some health plans may follow a plan year schedule instead. This means that it will renew on the date that your health insurance policy renews in the new year rather than January 1st. Understanding your plan’s deductible schedule can help you avoid unexpected medical costs. For example, if you were planning on waiting until after the holidays to get a medical service, and your plan renews based on the calendar year, you’ll want to rethink that plan. On the other hand, if it renews on your plan renewal date, you may have some wiggle room.
What does “no charge after deductible” mean?
This phrase means that once you meet your deductible the insurance company will cover the full cost of covered medical expenses, up to the plan’s limits. However, most health insurance plans usually only pay 100% of medical costs once you’ve reached your out-of-pocket maximum.
Is my deductible the same as my out-of-pocket maximum?
No, they work similarly in that they serve as a limit to how much you have to pay for your covered medical expenses, but the limits are two different things. Your out of pocket maximum is the most you will pay in one year. Once you’ve met this limit your insurance will cover 100% of all additional covered medical costs for the year in full. Your deductible is how much you pay before your plan begins their cost-sharing feature with you, such as your coinsurance.
Anything that counts towards your deductible also counts towards your out-of-pocket maximum as well. As noted above, there are some costs such as your copays and coinsurance that don’t count towards it, but will count towards your out-of-pocket maximum. Think of your deductible as a milestone, once you reach it you pay significantly less towards your healthcare, reaching your out-of-pocket maximum is the end game once you reach that you pay nothing towards your covered healthcare costs.
Working With EZ
EZ.Insure offers access to local, highly-trained insurance agents who will shop around for the most cost-effective policy. We can save you hundreds of dollars annually by searching for a suitable plan both on and off the Marketplace. We can also determine whether you qualify for local discounts and apply them to your plan. The best part is that we do all of this without charge! Simply enter your zip code into the box below to receive free, instant quotes, or call us at 877-670-3557 to speak with an agent who can answer all of your questions and find you the ideal plan.
It’s hard to say which type of business insurance is most important for your business. They all cover specific things and keep your business protected in different ways. But there is one type of commercial insurance that you are most likely required by law to have if you have employees: workers’ compensation.
This type of policy covers you and your employee if they are hurt while working, or sick because of workplace conditions. Workers’ comp in nearly every state covers medical expenses, disability, rehabilitation, and death benefits. And while there is some uniformity in regard to the benefits available to injured workers across the country. There is considerable variation in the amounts and methods each state distributes. If you want to find out more about how workers’ comp works in your state, check out our state-by-state guide. Then talk to an EZ agent about what you need.
First, though, read on to find out more about how workers’ comp covers these four benefits (medical expenses, disability, rehabilitation, and death). So, you know exactly what to expect from your policy.
Medical Expenses
At its core, workers’ compensation covers medical expenses incurred by employees who get sick or hurt on the job. It will cover most medical expenses for most legitimate claims. Including bills that come from visits to the doctor, inpatient care, skilled nursing care, medication, diagnostic imaging, physiotherapy. And the cost of long-term supports like walkers and wheelchairs.
In some states, though, there’s no coverage for “alternative” therapies like biofeedback and massage. And it’s possible that one state may cover a treatment while another won’t. Additionally, in some states there are limits on certain treatments. For instance, the law might allow no more than twenty-four visits to a chiropractor or physical therapist.
In most cases, workers’ comp does not have spending caps, deductibles, or copayments. And workers will be eligible for benefits until they have made a full recovery from their injury.
Managed Care
A managed care organization (MCO) is a healthcare provider or group of healthcare providers that has a contract with an insurer or self-insured employer to provide managed healthcare services to enrolled workers. In many states, benefits through a managed care plan can be provided by employers or workers’ compensation insurers to get injured workers the care they need. In fact, insurers in some states legally have to offer this option to businesses.
Managed care plans are governed by a wide range of statutes. Typically, a plan will include some combination of the following:
Provider Networks – A network of medical professionals who have agreed to provide discounted services to members of an insurance pool or employee group. In some states, injured workers will have to receive care from in-network providers.
Utilization Management – This type of management is intended to ensure that the type of medical care that is provided to workers is necessary, appropriate, and efficient with regard to costs. Before carrying out particular medical procedures, providers might be have to get prior approval from the insurance company.
Pharmacy Benefits Manager – An administrator of a program that purchases prescription drugs whose job it is to limit spending. A pharmacy benefit manager (PBM) is responsible for establishing formularies, negotiating discounts with drug manufacturers, forming contractual relationships with pharmacies, and paying claims for prescription drugs.
Medical Care Management – This type of management provides supervising care to make sure that injured workers get the appropriate treatment they need. So, that they can get back to work as quickly as possible.
Disability
Disability benefits compensate an employee for a portion of the wages they lose while they are unable to work as a result of an injury on the job. For instance, if a construction worker breaks their leg in an accident. It is highly unlikely that they will be able to return to work until they have fully recovered. Because of the amount of time this will take, they will require financial assistance during this time when they cannot work.
“Disability” as it relates to workers’ comp has four distinct categories:
Temporary Total Disability (TTD) – To receive TTD benefits, your employee must have been injured so severe that they will not be able to return to work at all for a long time. For example, if a worker sustains an injury to their back and is subsequently unable to perform any duties for six weeks, but will then return to their regular responsibilities.
Temporary Partial Disability (TPD) – Your employee has a relatively minor injury that has only temporarily rendered them partially disabled. For instance, a worker breaks their arm while they are on the job and must work reduced hours. They’re able to still work just not to their full capacity.
Permanent Total Disability (PTD) – If your employee has an injury that will not heal and will be unable to generate income in the future by performing the kind of work they were doing at the time of the injury.
Permanent Partial Disability (PPD) – The injury your worker suffers might affect them permanently, like an injury that causes hearing loss, but they might still be able to work. The injury, though, might prevent them from earning as much income as they did before their injury.
Disability Payments
The severity of a worker’s disability will determine how much money they will receive from workers’ compensation benefits. In general, your employee’s average weekly pay prior to the injury is the basis for the calculation of benefits. This amount, though, might be subject to minimum and maximum limits, depending on your state. There will be a waiting period before benefits are provided, which is typically one week. If the disability lasts less than that period of time, your employee will not be eligible for benefits.
Typically, disability benefits are as follows:
Temporary Total Disability – With TTD, benefits will be paid while your employee is recovering. Typically, these benefits are calculated as a certain percentage of the worker’s average weekly wage. For example, if a worker whose normal weekly wage is $1,000 is unable to work due to a broken leg for a period of two months. They will get a total of $667 weekly over the course of the eight weeks.
Temporary Partial Disability – With TPD benefits, your worker will typically receive their normal pay in addition to a percentage of the difference between their normal pay and their reduced pay. This is the case when the worker receives compensation for work that they are able to perform. For instance, a worker who sustains an injury to their leg is unable to perform their regular job duties because those duties require them to stand. They typically make $1,000 a week. During the two months that it takes for their leg to heal, they are responsible for performing administrative work. This job only pays $500 each week. So, there is a difference of $500 per week between their regular pay and their current pay. They will earn $500 per week plus $333 (66.66% of $500). For a total of $833 per week while they are unable to perform their normal duties.
Permanent Total Disability – A worker who is totally and permanently disabled will typically receive compensation equal to 66.66% (or some other specified percentage) of their previous average weekly wage for the rest of their life. When an employee reaches the official retirement age in some states, the benefits they have been receiving will end.
Permanent Partial Disability – A permanent partial disability may be classified as either “scheduled” or “non-scheduled” in some states. Injuries on the schedule typically involve a specific limb, organ, or part of the body. A worker who suffers a permanent injury to a body part in the schedule can receive disability payments for a specific period of time. If an employee loses a finger on the job, for instance. They may be eligible for 45 weeks of disability pay at 66.66% of their regular wage.
Disability benefits for employees with a permanent partial injury not on a schedule are determined in accordance with applicable state law. Benefits may be calculated in accordance with the worker’s degree of impairment, loss of earning capacity, wages lost. Or some other factor, depending on the state.
Rehabilitation
The part of workers’ compensation that covers rehabilitation helps if something catastrophic happens to an employee that prevents them from working and requires long-term treatment for recovery. For example, if an employee has a history of mental breakdowns, such as after prolonged exposure to toxic stress. They may not be able to work for a time. But rehabilitation and therapy during this time may help them recover. Although they may no longer be able to return to your place of work.
Rehabilitation can also include a service called Transferable Skills Analysis, which can help the employee in these situations. The goal of this program is to assist participants in securing gainful employment that puts their acquired skills to use. Their benefits cover the cost of a case manager who will assist them in their job search.
Death
If an employee dies on the job, his or her dependents will receive workers’ comp death benefits. This protection is in place to help families deal with the monetary fallout of a loved one’s death. This type of coverage will help the deceased’s loved ones pay for funeral expenses. And help replace the income they would have otherwise received.
It’s important to be aware of the laws and regulations in your state before purchasing workers’ compensation insurance. It’s also vital that you stay well-informed on your insurance policies. So, that you can communicate effectively with your staff in the event of an accident.
Working With EZ
EZ.Insure knows that in order to succeed, businesses must have all the information possible. That’s why we’re here to answer all of your questions about the commercial insurance policies you need! But don’t worry, we know that your time and money are valuable. So, you won’t pay anything for our services. And you won’t have to worry about being inundated with calls from your agent as they answer your questions, help you compare plans, and sign you up when you’re ready. To start, either enter your zip code into the box below or call 877-670-3538 to speak with an agent. Thanks to EZ.Insure, getting insurance is a breeze.
So, things didn’t turn out the way you wanted to, did they? It’s okay. (Obviously, it’s not okay, but the more you repeat it, the more it may bend things in that direction.)
You’ve got your work cut out for you. A broken heart is a registered grief type. It’s got its own Wikipedia page and everything. This pain has been in human history for thousands of years. It may not help, but you’re not alone in this. It’s something that everyone has to deal with at one point or another.
The first thing to remember is that like any grief, we all experience it differently. You can read all the books for similar symptoms and occurrences, but truly, you need your own guiding hand in this. So be aware of your state. However, I’ve found some solid guidelines that help.
Be Kind to Your Broken Heart
I know this storm. You’re feeling like everything is closing in, and you can’t breathe. You’re inundated by thoughts, hauntings, and memories of them. It all hurts. Or–maybe it’s been a while, and now you’re just tired. Tired of feeling bad. Tired of the pain. Just remember, a broken heart is a wound, and it needs kindness and tending like a physical one.
It’s not an easy thing, especially when you remember how things were before.
But, this is something you can control. Emotions are mercurial, but not entirely out of our hands.
You need to start by being kind and soft to yourself. Your friends and family can be there as much as possible, and that makes a whole world of difference, but that emotional shell of sadness is hard to penetrate. They can’t be there all the time, during all those late night thoughts and memories.
But you can.
Show up for yourself. Be your own champion. Tell yourself you’re not crazy, that you can feel sad. You can rage. Be kind to yourself first and foremost in this process.
This starts with small steps like making your favorite breakfast. You may not want to eat it but do it anyway. Is there something you’ve been wanting to do for a while? Now is the time to do it.
More than any other time, you need to prove that you’ve got your own back. For more steps, take a look at this list here.
Channel Your Emotions
Whether you want to or not, you have to get the storm outside of your body or mind and into reality. It’s easier that way. Now, I’m not saying to go on a bender or smash up something as an excuse for “dealing,” Remember, hindsight is 20/20, so if you do something in the height of passion, you may regret it later.
You’ve got to be there for yourself now more than ever. It’s the healthiest thing to do.
Meditation or yoga are great for any type of grief or stress. Remember, your mind is like a muscle, and it can get sore too. Carrying around all of that sadness, anger, shame, anything you’re feeling right now is going to exhaust you if you just cling to it. Of course, everyone processes differently, but please, if you do nothing at all, meditate. You have to set the emotional stuff down for at least 20 minutes a day.
Art has always been an amazing channel for emotions, especially heartbreak. Some of the greatest love stories ever told, perhaps you can think of a few right now, began with the seeds of what you’re carrying.
Plant this garden in yourself. Allow it to be focused into something good, not for anyone else, for you. Use this to become a better person.
Write poetry or songs. Paint something. Dance on a rooftop under a full moon. Sometimes, even just driving to a secluded spot and screaming can help.
Not into art? That’s fine. Find what makes you feel good and lean into it. Work is another good choice. Sure, it won’t erase the pain, but getting a heftier paycheck may destress other parts of your life.
If you can just bear with it, breath by breath sometimes if you have to, it will ease. It sure won’t feel that way at first though, but keep in mind, you won’t have to relive the worst days again. Repeat to yourself, “I’m not just a broken heart. I’m so much more.”
Let Go to Heal Your Broken Heart
I saved this one for last because it is definitely the hardest.
And I know. I know exactly how you feel when you read those words. How could you? How could you ever just set this down and move forward? You don’t have to at first, or even in a week or a month or a year, but at some point, you must.
Life will dance merrily forward around you, even if you’re not dancing too. Regret is something we all live with, but you don’t have to let it rule you. It’s not worth it in the long run.
This is also last because it’s the final step. The love that you had is gone. Take a deep breath. It’s gone. But you’re not. You have your memories and yourself.
When you clutch that last remnant of what was or what might have been, you’re only hurting yourself. But I get it. When you unclench that desperate grip on that feeling, you’re surrendering to the reality that it’s over. It’s the last thing to unsling from your back to the floor, and with that, you’re the one putting an end to it.
And you don’t want it to end. Do you? You want to hold that door open. You wish for something to change–for them to come back, for them to say sorry, for them to be alive again.
The truth is, those are only possibilities, and you, dear reader, live in reality.
Reality is a tough, miserable place right now because of this, and possibility is a sweet, addictive cloud that keeps you bound in painful hope. It’s a place to stay, for a while, but never a place to live.
Let yourself feel sad. Don’t deny your feelings or try to cage them.
When anyone comes to the doorstep of grief, it changes them. We have no choice in that, but we do have a choice in how it changes us. Let the actions you take now forge you closer to your best self.
I know I said earlier to let go, but let’s take a trip back down in memory, just for a moment. Remember the first feelings of love? When you first started the relationship? They felt amazing, right?
You deserve those feelings. You’re worth finding that. It may seem dismal now, but it’s true. The storm you’re feeling now is the most beautiful thing because it shows your capacity to love someone. In the shadow of your broken heart, you can see your true strength.
So remember: you’re not alone, and you’re not crazy. Be kind to yourself because you need to be the one to save you right now. Find a way to channel your emotions even if you don’t want to at the time, and let go. Say goodbye and mourn what is lost.
