Health Insurance Archives - Page 4 of 52

Will Health Insurance Cover My Breast Reduction Surgery?

Will Health Insurance Cover My Breast Reduction Surgery? text overlaying image of a woman holding large pumpkins over her breasts The average size of a woman’s breasts in the United States has steadily increased over the past five decades, from a 34B in 1983 to a whopping 34DD in 2023. And that’s just the average; bra sizes go all the way to H. While a larger cup size can be appealing to many, it can also be debilitating.

In many instances, a woman’s breast size can impede her ability to work, exercise, and even care for her family. Multiple seemingly unrelated areas may experience pain as a result of the weight of breasts that are disproportionately large. After years of wearing “industrial style” support bras, ridges form across the upper shoulders, straining the muscles and frequently causing headaches and neck pain. The delicate skin beneath the breasts is susceptible to inflammation and infection. Chronic lower back pain is a common complaint among women who compensate for their posture by shifting their weight.

Health insurance is one of the most unexpected “obstacles” for women interested in breast reduction surgery.Many of these women are well into the process of preparing for surgery, researching surgeons and enduring (often multiple) consultations and examinations, when they discover that their insurance policy does not cover the necessary procedure.

Reasons For a Breast Reduction

A breast reduction, also known as a reduction mammaplasty, is a surgical procedure that reduces your cup size by removing excess breast tissue, fat, and skin. Due to the negative effects that large breasts can have on their health, many women opt for this surgery. Common health problems that are associated with oversized breasts include:

Neck pain
Back pain
Shoulder pain
Rounded shoulders (kyphosis)
Poor posture
Shoulder grooves from bra straps digging into the skin from inadequate support
Numbness in the chest, arms, or fingers due to nerve compression
Breathing problems, specifically while laying down or sleeping
Skin rashes and infection, typically in the fold beneath breasts
Migraines

The Cost of Breast Reductions

As of 2023, a reduction mammoplasty can cost between $4,822 and $11,442. This includes the fee for a board-certified plastic surgeon, hospital fees, medical and diagnostic testing, surgical and post-op garments, and medications. This doesn’t include the cost of anesthesia as it can vary greatly depending on the amount used. The surgeon’s fee also varies based on their level of experience and expertise, their surgical techniques, and whether they perform the surgery in an outpatient hospital or a surgical center.

Health Insurance Coverage

As long as the breast reduction surgery meets the criteria for medical necessity, the majority of insurers provide full or partial coverage. Breast reduction is usually considered cosmetic by major insurance companies unless your breasts cause symptoms such as numbness and tingling, ulceration, significant pain, or persistent rashes. In order for an insurer to cover the procedure you have to prove that you have attempted to treat these issues with other means, such as medication or physical therapy. If you can demonstrate that the procedure is medically necessary, the insurer may classify it as reconstructive rather than cosmetic and provide coverage. Health insurance will cover breast reduction if:

You have breasts that are large enough to be reduced by at least 3 cup sizes.
The rashes or strap marks cannot be treated properly without the reductions.
Your breast size was unaffected by documented weight loss.
Your head, neck, shoulder, or back pain persists despite regular therapy visits.
The size of your breasts prevents you from exercising and maintaining a healthy body weight.

Like we said above, you have to prove that you have exhausted every other treatment option over a course of 6 to 12 months in an effort to resolve any complications your breast size causes. Your insurance company will only consider covering the breast reduction surgery if you provide documentation of all these health problems and attempted treatments. Even if you are approved you may still have to pay a portion of the surgery, in addition to any deductible or coinsurance associated with the procedure.

Steps To Getting Your Breast Reduction Covered

There are a few steps you may have to go through to make sure your health insurance will cover your breast reduction, including the following:

Meet with your PCP

It’s important to meet with your PCP to discuss all of your symptoms first. A PCP will record your pain, and discuss treatments you can start since most insurance companies will want proof that you tried to treat this without surgery. Don’t forget to include every symptom, even if they seem small like minor aches, or discomfort from your bra. Any and all symptoms recorded will help you later down the line when you’re asking for approval for the surgery.

Understand your benefits

Read through your health insurance benefits of the company’s online resources to learn about your specific level and type of coverage. This will help you find out if you can even get breast reduction surgery covered at all. However, don’t always rely on your own interpretation of your benefits. Reading through will help you gain some understanding about the coverage or what documents you need, but don’t stop there.

Call your insurance company

You can ask your company directly if they will cover the surgery and if pre-approval is necessary for breast reductions. Nextask what kind of documentation you will need to prove medical necessity. You also need to find out if your insurance company will require you to use a plastic surgeon within their network.

Pre-authorization

Even if you have a comprehensive health insurance plan that generally covers breast reductions. You will still need to provide proof that the procedure is medically necessary. Before you can schedule surgery, you must first give your insurance company medical records from licensed physicians showing that you have physical complaints and have attempted less extreme treatments. These documents may require a six to 12 month backdate. The physician notes you may need include your OB/GYN, primary care physician, orthopedic surgeon, and physical therapist, among others.

In addition, the majority of plastic surgeons recommend that you have documentation of any complementary and alternative medicine therapies such as acupuncture or chiropractic care. During your initial consultation for breast reduction, your doctor may take photos of your pro-op breasts for insurance purposes. Additionally, they can provide you with a note detailing the symptoms that prompted you to seek breast reduction. All of this documentation will be reviewed by a panel of medical professionals that work for your insurance company. They will evaluate your medical history and determine if breast reduction surgery is medically necessary for your case.

Initial Rejection

According to AARP, up to 14% of all initial insurance claims are denied. However, this doesn’t mean it’s impossible to get coverage. You have the ability to appeal the denial. You do this by having your surgeon write a letter to the insurance company explaining why you qualify for the surgery. It’s also wise to get letters of support from any other medical professionals to strengthen your case.

Authorization

Once your paperwork has been accepted and your insurance company has given its approval, you can go ahead and schedule your breast reduction surgery. The majority of insurance providers will require you to pay a copay for the hospital or medical facility stay. Which can range from $100-$300.

Is A Breast Reduction Ever Automatically Covered?

You won’t need to document a long history of trying to relieve symptoms if your reconstructive surgery is tied to a mastectomy. Which is a breast cancer surgery that removes the entire breast. It is usually offered to women who can’t or doesn’t want to be treated with breast conserving surgery. Which would save most of the breast while removing the cancer cells. It’s also offered to women who have a high risk of getting second breast cancer. In this case, the patient can choose to get a double mastectomy, which will remove both breasts. Now say prior to having your mastectomy you had all of these health issues because you had large breasts. Once you have the mastectomy you are able to get reconstructive breast surgery and your breasts will be a proportional size to your body, therefore alleviating the medical conditions.

Working With EZ

Having breast reduction surgery can significantly improve your quality of life. So, it’s unquestionably worth investigating, especially since some insurance policies will cover the procedure without much hassle. You could enjoy a more active lifestyle with less pain or discomfort. If you are looking for a company that will cover breast reduction surgery, come to EZ. One of our agents will research and compare all available plans within your budget. EZ understands how difficult this pain can be and we want to make getting health insurance one less headache (or backache) for you. Your personal agent will compare all of the quotes in your area. As well as answer any questions you have for free. To get started enter your zip code into the box below for your free instant quotes. Or call one of our licensed agents directly at 877-670-3557.

HSA vs FSA

hsa vs fsa text overlaying image of a piggy bank Because of the constant yearly rise of health services and health insurance premiums, healthcare has become a large portion of everyone’s personal budget. However, as these costs have increased over the last few decades, medical savings accounts have come into play to help offset them. There are a few different accounts you can choose from to help you save money towards your healthcare, but we’re only going to be looking at 2 of them: Health Savings Accounts (HSAs) and Flexible Spending Accounts (FSAs). Both HSAs and FSAs are savings accounts that allow you to save specifically for medical expenses. Aside from that fact, the two accounts differ in a number of significant ways. In this article we’re going to compare and contrast them so you get an idea of what they are, how they work, and if one of them would be beneficial to you.

Health Savings Accounts (HSAs)

Health Savings Accounts are not typical savings accounts, and they are only available to people with a high-deductible health plan (HDHP). As of 2023 an HDHP is defined as any plan with a minimum deductible of $1,500 for individual coverage or $3,000 for family coverage with an out-of-pocket maximum of $7,500 and $15,000 respectively. An HSA is a triple tax advantaged account that can be used to pay for qualifying medical expenses. It’s known as “triple tax-advantaged” because your contributions to your account are not taxed, the money in the account is never taxed while it’s in the account, even if it earns interest or investment returns.

Additionally, as long as you use your HSA funds for qualified medical expenses, your withdrawals will also never be taxed. However, if you use your HSA funds for anything besides qualified medical expenses you will have a 20% tax penalty. Another great thing about HSAs is that you can actually invest your funds as well, similar to the way you would a 401K. This lets your HSA actually make you money, if you invest properly you could end up with a nice health savings account keeping you from having to pay for little to any of your healthcare.

How HSAs Work

If you open an HSA with your HDHP, you will deposit money into the HSA that you can use to pay for qualified medical expenses that your health plan does not cover. Which are any services that the IRS recognizes as a eligible medical costs these expenses include:

Acupuncture
Ambulance services
Birth control/contraceptive devices
Blood pressure monitors
Blood sugar test kits/test strips
Chiropractic therapy/exams/adjustments
Contact lenses
Copayments
Dental care
Dermatological services
Diagnostic services
Eye exams
Eye surgery
Flu shots
Gynecological care
Incontinence supplies
Infertility treatments
Insulin and diabetic supplies
Laboratory fees
Lactation expenses
Legal sterilization
Laser eye surgery/ LASIK
Menstrual care products
Nasal strips
Obstetric care
Over the counter (OTC) treatments containing medicine (i.e., cold treatments, pain relievers, sinus medications, etc.)
Physical exams
Pregnancy test kits
Smoking cessation programs
Therapy or counseling
Treatment for alcohol or drug dependency
Vaccinations
Vision care
Wrist supports/elastic straps
X-ray fees

You can use the HSA funds to pay all your medical bills until you reach your plan’s deductible, and then you can use them to cover your coinsurance or copayments until you reach your annual out-of-pocket maximum. Additionally, unlike other health spending accounts, HSA funds will never expire. Your funds roll over into the new year, every year so you don’t have to rush to spend the money in the account. One thing you should note though, is that HSAs do have a contribution limit, these limits change annually but as of 2023 if you have an individual plan you can only contribute up to $3,850 for the year. For family plans the limit is $7,750.

Flexible Spending Accounts (FSAs)

A Flexible Spending Account, sometimes called a Flexible Spending Arrangement, is a type of savings account that offers you specific tax advantages. You don’t actually set these accounts up, instead they are set up by your employer. FSAs let you contribute a portion of your pay into the account. Your employer can also choose to contribute to the FSA on your behalf, sort of like when your employer matches your 401K except the employer decides exactly how much they contribute. The FSA funds are then used to reimburse you for eligible medical and dental expenses.

How FSAs Work

An FSA is a voluntary plan that allows employees to contribute up to $3,050 a year (as of 2023) to pay for eligible medical expenses that are not covered by their health insurance plan such as:

Health insurance copayments
Doctor’s visits
Coinsurance payments
Dental work
Vision expenses
Prescriptions
Therapy and counseling services
Chiropractic care
Acupuncture
Hospital fees
Surgery costs
Diagnostic services
Allergy testing

If your employer offers group health insurance they can also offer these FSA plans as an additional employment benefit. Your employer can choose to also contribute to your FSA, they can choose to match your contributions or decide to pay a smaller amount. They are not required to contribute though, so some employers might not add into your FSA at all. If your employer does choose to contribute, their contribution typically won’t count towards your yearly limit no matter how much they contribute.

The Differences

You can’t have both of these plans at the same time, so if your employer offers an FSA but you’re also considering an HSA, you’ll want to keep these key differences in mind when you’re making your decision.

Qualifications

Compared to FSAs, HSAs have stricter eligibility requirements. To qualify for an HSA, you must have an HDHP. The HDHP has to be your only health insurance. Additionally if you are eligible for Medicare or are a claimed dependent on someone else’s taxes you can not open an HSA. On the other hand FSAs have to be set up by your employer, which automatically excludes self-employed or unemployed people. Your employer does have some qualifications they have to meet to be able to offer FSAs. For example they can only contribute to employee FSAs if they own less than 2% of the company. However, if they already offer these plans then there’s no other eligibility requirement on your end, all employees are eligible even ones without health insurance plans.

Annual contribution limits

Since contributions to these accounts are tax free they lower your taxable income. Because of this the IRS has placed limits on these plans. For FSAs the contribution limit is $3,050 as of 2023. For HSAs it’s $3,850 for individual plans and $7,750 for family plans.

Rollover rules

One of the biggest advantages of an HSA is that your funds roll over, meaning there are no time restrictions on using your funds. Since the account belongs to you, you get to decide when and how to use the funds. However for FSAs it’s not as simple. Unused funds are not automatically carried over into the new year. Since your employer owns the plan they decide what happens to the funds. Employers have 3 choices when it comes to rolling funds over:

- Forfeiture – This means any unused funds will not roll over. Instead, they will be transferred to the employer.
- Grace period – This is a 2 ½ month period after the plan year ends to use the last of the fund in the account, after this time frame, the funds then go to your employer.
- Carryover- This allows employees to take $500 of the unused money over to the new year’s plan. Any funds left in the account after the $500 is carried over goes to the employer.

Changing contribution amounts

This is another point where HSAs are simple. You can contribute any amount you want at any time, you don’t have to keep the same contribution every time. Whereas with FSAs your contribution amount stays the same through the year. You can only change your contribution amount 3 times. First at open enrollment, when the plan renews you can decide to change your contribution amount for the new year. Next is if there is a change to your family situation such as a marriage, death, or birth you will be allowed to adjust the amount. Lastly, if you change employers when you enroll in your new employer’s health plan, assuming they offer one, you can select your new contribution amount since it’s an entirely new FSA.

Keeping your account when changing jobs

Unlike FSAs, HSAs follow you no matter how many times you change jobs because your account belongs to you. With FSA’s, they belong to your employer so unless you qualify for COBRA, you will no longer have access to your FSA if you leave your job.

Which Is Better?

If you qualify, the higher contribution limits and contribution rollover of HSAs make it the better option overall. HSAs are more flexible than FSAs, allowing you to save money over time for potential medical expenses. However, unless your job allows you to roll over $500 annually, your FSA balance will not build up over time. Depending on your employer’s decisions, unused funds are generally forfeited to your employer at the end of this year, meaning if you didn’t have many medical expenses for that year you could be losing money.

However, most of the time choosing between them is more dependent on your situation rather than which one you actually prefer to have. This is because the decision will depend if your employer even offers an FSA and whether or not your health insurance plan is an HDHP.

Getting Help With EZ

Both of these options can be excellent tax-free ways to save, invest, and pay for medical expenses, and EZ can help if you’re interested in HSAs. If you choose an HDHP, open an HSA as soon as you are eligible and begin contributing. Since these accounts continue to be one of the most effective ways to reduce expenses and improve your overall financial standing. To begin saving immediately, enter your zip code in the box below to receive free instant quotes. Or, contact one of our licensed agents at 877-670-3557.

Is A Short-Term Health Plan Right For You?

is a short-term health insurance plan right for you? text overlaying image of a clock on a yellow background If you’ve missed the health insurance Open Enrollment Period (OEP), or if you have had a sudden lapse in your insurance coverage, you might be stressing over how to get covered. But don’t worry, you still have options! One of your best options will be a short-term health insurance plan. These plans tend to be less expensive than traditional health insurance because they provide very limited coverage, and so they are usually meant as a stopgap for generally healthy people. So, what do these plans cover (and what don’t they cover), and what are the specific rules surrounding them?

What Short Term Plans Cover

Compared to traditional health insurance plans, which typically include a comprehensive range of benefits, short-term health insurance plans offer significantly less coverage. In fact, they are not required to provide coverage for the “10 essential health benefits” that traditional ACA-approved plans are required to cover.

That means short term health plans are not required to provide coverage for:

Pre-existing conditions
Medications
Maternity care
Mental health
Substance abuse treatment

But, with that being said, short term health plans are better than nothing, and generally provide coverage for:

Hospitalizations
Outpatient surgeries
Emergency room and urgent care visits
Doctor visits
Prescription drugs

The Cost of Short-Term Plans

What you can expect to pay for a short-term health plan will be determined by the specific plan that you choose, as it would be with any other type of insurance. You will be responsible for paying a monthly premium, in addition to:

Deductibles – As with other types of insurance, with a short-term plan, you pay for services out-of-pocket until your deductible is met. After that, your plan will start to split costs. Short-term health plans can have deductibles that are much higher than those of other, more traditional health plans.
Coinsurance – After you’ve met your deductible, your plan will cover your medical expenses in part, but you will also have to pay a percentage, known as coinsurance. For example, you might have to pay 30% of each covered medical expense, while your plan covers 70%.
Copays – This is a set fee that you may have to pay when you use a medical service. For example, you might have to pay $20 at the point of service when you go to the doctor.
Other expenses – If there are health care services that your short-term plan doesn’t cover, you might have to pay for them completely out-of-pocket. For instance, some short-term plans might not cover or only cover a certain amount of maternity care, mental health or substance use services, vision care, or dental care. If you need these services, you’d have to pay for them yourself.

One good thing about the costs of these plans is that their monthly premiums are typically much more affordable than the premiums for plans offered under the Affordable Care Act (ACA). With that being said, the reason that they are sold at a lower price is because most of the time, these plans don’t cover much, and only a portion of the monthly premium actually winds up being applied toward the cost of actual medical care.

Short Term Plans State-by-State

When it comes to the rules surrounding short term plans, every state is different. In fact, some states don’t even allow residents to buy these plans, but most allow a limited length of time to have one of these plans.

The following states allow you to have coverage with a short-term plan for 364 days, and allow you to renew up to 3 times for a total of 3 years of short-term coverage:

The next set of states allow for coverage from short term plans to last between 1 and 3 years:

Kansas – 365 days for your initial plan and 1 renewal, giving you a total of 24 months.
Maine – 364 days for the initial plan, with 1 renewal for a total of 24 months
Ohio – 364 days, no renewals
South Carolina – 11 months for the initial plan, plus allows 3 renewals for 33 months in total.
Wisconsin – 364 days, allows for renewal but only for a maximum of 18 months of coverage

If you live in the following states, your initial term with one of these plans can be be up to 6 months:

Connecticut
Illinois
Michigan – 185 days (just over 6 months)
Minnesota – 185 days
Missouri – allows for renewals for a total of 36 months of coverage
Nevada – 185 days
New Hampshire

The next states have an initial term of 3 months:

Delaware
Maryland
Oregon
Vermont
Virginia – allows for 1 renewal for up to 6 months of coverage
Washington

The last set of states have either banned or no longer offer short term plans due to a change in their laws:

For more in-depth information on your state’s laws surrounding short term insurance, check out our state-by-state guides to health insurance.

Pros and Cons of Short-Term Plans

Short term plans can give you a number of advantages. But you should be aware that there are some drawbacks to this option as well. Knowing both the pros and cons of these plans will help you make an educated decision.

Pros

Affordability – The low price of these plans’ premiums is a highly attractive benefit.
Quick coverage – Plans usually go into effect within 7-14 days of enrolling.
Easy Cancellation – It is possible to terminate short-term insurance plans with little advance notice, particularly if you pay for your plan on a month-to-month basis.

Cons

Renewal Limitations – Short term plans do not automatically renew, and the number of times you are allowed to renew them is usually capped.
Coverage Limitations – In most cases, a temporary health insurance plan will not include coverage for all ten essential health benefits.
Availability Limitations – Not all states or insurance companies offer short-term plans to their customers.

Qualifying for Short Term Health Insurance

As discussed above, the majority of states permit short-term health plans, but there are a few that do not, and others that place restrictions on how long coverage can be maintained.

But even if your state permits short-term plans, you may still be denied coverage by an insurance company for health reasons. For example, you might be denied a short-term plan if you have a serious preexisting medical condition, or if you’re currently expecting a child.

In general, you will qualify for short term plans if you:

Are young and healthy.
Missed the OEP, and don’t qualify for a Special Enrollment Period
Are out of work and can’t afford COBRA or an ACA plan and need coverage in the meantime.
Are almost eligible for Medicare but do not want to enroll in a full year-long plan.

If you have a pre-existing condition, such as asthma or diabetes, you might want to steer clear of short-term plans even if you can get approved, because your premiums will be significantly more expensive, since these plans are not subject to ACA rules on preexisting conditions.

How to Buy Short Term Plans

Although you may be able to enroll in a short-term plan in person in some circumstances, the most common method for purchasing short-term health insurance is doing so online. You can also contact an insurance company that specializes in selling short-term plans directly.

Because of the state regulations surrounding short term health plans, and because these plans are offered by both national and regional companies, their availability is highly dependent on the state you live in. National companies sell short term health plans in multiple states, and regional companies have more localized service areas, so you’ll need to shop around. Speak to an EZ agent about what companies in your area offer the best short-term health plans.

FAQs

Will my doctor accept short term health insurance?

It depends on the plan. Some plans require you to stay in their network of doctors, with other plans, you can choose your own doctor and hospital without being subject to any restrictions. With that being said, in this case, there may still be financial incentives for using in-network providers.

Are pre-existing conditions covered?

When you apply for a short-term health plan, you’ll have to answer a short list of questions about your health, including about preexisting conditions. There’s a chance you will be denied coverage if you have certain preexisting conditions, and even if you are considered eligible for coverage, your plan will most likely not provide coverage for treatment of your preexisting condition.

So, when applying for one of these plans, examine the policy’s wording thoroughly. It’s common practice for short-term plans to use post-claims underwriting, which means that they’ll take your word for it about your health when you sign up, but can check your records after you’ve filed a claim to make sure you weren’t lying about any preexisting conditions.

Is losing my short-term coverage considered a qualifying life event?

Since short term health plans are not ACA-approved plans that provide minimum essential coverage, losing such a policy does not warrant a Special Enrollment Period that will allow you to shop for an ACA-compliant plan outside of Open Enrollment.

So, is a Short Term Plan the Best Option?

The purpose of short-term health plans is to provide healthy people with temporary, limited protection. Therefore, those who have ongoing medical needs or who have a history of illness should avoid short term health plans. If you’ve lost your coverage, and are in-between plans and looking to cut costs, short term health coverage is the way to go. But before you make a purchase, you should think carefully about whether or not it will meet your needs.

You can get information on short term health plans by contacting EZ.Insure and speaking with a licensed agent. We’ll go over all the details with you and help you figure out if one of these plans is right for you. And if it turns out a short-term health plan isn’t the best option for you, we’ll find you something that fits your budget and your health status. Get an instant quote by entering your zip code in the box below, or to speak to an agent directly, call 877-670-3557.

Avoiding Unexpected Medical Bills

avoiding unexpected medical bills text overlaying image of past due bills In general, bills of any kind are met with groans, but unexpected medical bills are undeniably the worst. They have a habit of coming at the worst time and weeks or even months after you’ve seen a doctor or had a procedure. Despite the inconvenience they’re far more common than you would think even when you have health insurance. Unfortunately, not everything is covered by health insurance, which is a bitter pill to swallow considering how expensive it can be.

While we have no control over which services are covered (or how much we have to pay for them), we can understand exactly what the benefits and coverage are. As long as your deductible is met, you generally don’t have to worry about paying for routine exams, surgical procedures, or lab work. However, some procedures are excluded. These are primarily “elective” procedures, such as weight loss surgeries. Unless you are a special case, your chances of having them covered are slim. Below we’ll go over what insurance companies typically cover, what they won’t and how to avoid expected medical bills.

What Most Health Insurance Plans Cover

Typically, depending on the type of plan you have, most health insurance plans cover:

Hospitalization
Maternity and newborn care
Emergency services
Electrocardiograms
X-rays
Preventative services such as:
- Annual check ups
- Routine blood work
- Cancer screenings
- Blood glucose tests
- Vaccines
- Blood pressure monitoring
- Blood cholesterol monitoring

The primary differences in these coverages depend on your company and the plan tier you choose. For instance, some of these could require copays or coinsurance.

What Health Plans May Not Cover

Surprisingly, there are a lot of things that are either not covered or are only partially covered by most insurance companies.

Travel vaccines

Typically, insurance companies will only cover routine vaccinations that are needed in the U.S. Tropical disease vaccines are not covered if you are traveling to other countries. Most health insurance companies see these as not medically necessary.

Acupuncture

Even though there are numerous studies that show acupuncture has real medical benefits, health insurance doesn’t agree, since it doesn’t fit into most concepts of western medicine. An acupuncture visit can cost anywhere from $100 and up, out-of-pocket.

IVF

Unfortunately, many state health insurance plans do not cover in vitro fertilization (IVF). Whether you’re having trouble getting pregnant or just simply want to go a different route to your pregnancy, the procedure can cost between $10,000 and $20,000. Currently there are only 15 states that have laws making IVF coverage mandatory for health insurance.

Cosmetic surgery

In general, health insurance does not cover elective surgeries. Meaning that if the surgery isn’t approved by your physician for medical needs rather than cosmetic reasons it won’t be covered. For instance, if you have large breasts, a breast reduction is only covered if your doctor provides sufficient evidence that your breasts are causing health problems. Make sure you talk to your health insurance provider and doctor to avoid unexpected cosmetic surgery bills.

Dental and vision

This one can be surprising, but most health plans will not cover dental or vision care. There are however add-ons that you can purchase that are basically extra coverage specifically for these types of care. Additionally, things like LASIK (laser eye surgery) are seen as elective and not medically necessary.

Weight-loss surgery

Just like with breast reductions, unless your weight is causing severe health conditions your health plan will most likely not cover it. There is no federal law requiring health plans anywhere to cover these at all. Even if your doctor deems it medically necessary it can be very difficult to get these procedures covered.

Hearing aids

This is another surprising one, you’d think that hearing aids would be automatically considered medically necessary. And many people agree with you, this has been an ongoing argument in the United States for years. But as it stands most plans won’t cover hearing aids even though they’ll cover hearing exams. Currently only 4 states require hearing aids to be covered.

Out-of-network doctors

If you are hurt outside of your plan’s coverage area you’re probably out of luck. Your health insurance will most likely not cover out-of-network doctors unless it’s an emergency. And even then it’s tricky. However, there are plan types that do have some out-of-network coverage such as Preferred Provider Organizations (PPOs). They cover these doctors much less than their network providers but there is still some coverage there.

How To Avoid Unexpected Medical Bills

The good news is that you can avoid many unexpected medical bills by taking a few extra precautions before your appointments. Here are some simple strategies recommended by patient advocates and insurance professionals.

1.Read, Read, Read!

Every January, your health insurance company will mail or email you a packet containing all the information about your plan. Although the language can be a bit jargony and difficult to read, it’s in your best interest to read through this packet thoroughly. You can’t just assume specific procedures and services are covered. That is how you end up with unexpected costs. Instead you need to read the fine print to gain an understanding of what your plan’s specific benefits and limitations are.

We recommend highlighting important parts you think can or will pertain to you. Take note of your plan’s deductible, this is the amount you have to pay during your coverage period before your plan will begin paying for medical expenses. For example if you have a $500 deductible, you are responsible for paying for your medical costs until you reach that amount. After that your plan will pay for covered services in full for the remainder of the year.

You’ll also want to note which services are fully covered. For certain preventive services, such as a flu shot, annual physical, etc, you will only have to pay a copay with the remainder being covered by your plan. These things are essentially free so you’ll want to take advantage of them.

2.Stay In-Network

Insurance companies establish a network of covered healthcare providers, labs, and hospitals. Outside of the coverage area, you will face a huge financial burden. This is because your insurance company negotiates rates with their participating providers, giving you services for a cheaper rate. In general, health insurance plans do not have to cover care from out-of-network providers. However, there are a few exceptions. All plans legally have to cover out-of-network services if it’s an emergency.

To stay on the safe side, always make sure your provider is in your network before your appointment or any procedure. Prior to something as major as surgery you will definitely want to double check what your plan will cover. Make sure the facility, anesthesiologist, and equipment are all covered under your plan. That way you don’t end up with any unexpected costs.

3.Ask Your Questions

Even if you know your doctor or facility is in-network, always ask about coverage. If your doctor wants to perform a blood test, an EKG, or any other procedure or test during your appointment, ask if it’s covered before you consent. If the doctor is unsure, you can request the procedure’s Current Procedural Terminology (CPT) code and then call your insurance company to find out if it’s covered. This is helpful because your insurance may cover one type of mammogram for instance, but not another. Having this CPT code will make it easy for you to get a direct answer quickly to avoid unexpected bills.

4.Compare Costs

Comparing costs is a must! If your doctor sends blood work out to multiple labs, or if you have several pharmacy options near your home check the costs. One lab or pharmacy may be cheaper than another.

5.Get Preauthorization

By now it’s obvious the best way to avoid unexpected medical bills is to do your homework ahead of time. This is especially true when it comes to procedures. Most health insurance plans will require you to have pre approval for surgical procedures. If you don’t get the approval ahead of time you’ll face penalties or having to foot the entire bill yourself.

6.Expect The Unexpected

In the best-case scenario, you won’t have any medical emergencies, but plan ahead just in case. At the moment you won’t have time to call your insurer and ask which hospitals are covered. So, in your spare time, look up which hospitals near you are covered. Spend some time looking over your ambulance coverage as well. According to a study published in JAMA Internal Medicine, 85% of ambulance services end in out-of-network charges. In an emergency the most important thing is making sure you get the necessary care. We know you might not be in a situation where you can stop and ask if the ambulance ride is covered. However, in a non-life-threatening situation take a moment and ask if there’s a way to get an ambulance service that your insurance company will cover.

7.Document Everything

A simple phone call can provide you with a lot of answers to important questions. Such as whether or not a procedure is covered, if the physician is in-network, and which lab is preferred. But even after you get your answers, take one more step and get it in writing. Always request any information you get to also be sent in writing, regardless if it is a conversation with an advocate, the billing department, or a patient representative. This way you have everything you need in case you need to dispute any questionable charges.

The Final Step Work With EZ

All of that homework is a lot right? Well, here at EZ we can minimize all of this for you. By working with one of our highly trained licensed agents you can get all the answers you need in one place. They can compare all of your plans to make sure you get the best coverage for you as well as translate all the legal jargon in your insurance information packet from step 1. And they do it all for free! No hassle, no obligations. Enter your zip code into the bar below for free instant quotes to get started or call one of our agents directly at 877-670-3557.

How To Address Massive Medical Debt

How To Address Massive Medical Debt text overlaying image of a stethoscope laying on top of a pile of money a calculator and a medical bill Getting a large medical bill, or multiple bills can easily result in some serious debt. Healthcare services aren’t cheap, and if you don’t pay them off in time, you risk losing your assets, having poor credit, and possibly having to file for bankruptcy. In fact, medical debt is currently the leading cause of bankruptcy in the country today. When you get a medical bill, you typically have 180 days to pay it before it gets sent to collections. If you don’t pay the bill within that grace period your credit score will take a hit. A single bill sent to collections can drop your credit score by 50-100 points, and the unpaid medical bills stay on your credit score for 7 years!

Now say you use your savings to pay off your medical debt, you may not have the money to cover your other expenses, like bills or your mortgage. So now it’s a vicious cycle where one unpaid bill can turn into you falling into even more debt, losing your home, or worse. Not to mention, medical debt can then also affect your health. People with medical debt are less likely to seek medical care because they’re expecting even more debt from getting healthcare. As a result, not seeking healthcare causes your health to decline. Unfortunately, medical bills get expensive quickly, but there are steps you can take to prevent it entirely. Below we’ll look at what you can do to make sure you avoid medical debt and the downward spiral it can cause in your life.

Avoiding Medical Debt

The best thing you can do is avoid medical debt in the first place. We know sometimes that feels easier said than done, but it’s true. There’s plenty of ways you can avoid getting exorbitant bills and not have to worry about climbing out of medical debt.

Compare plans

Comparing your health insurance plan to make sure you’re getting the best coverage is the best place to start. Not all health insurance is made equal. There are plans that are better for people with less medical need and plans for people who need more medical attention. Choosing the right plan type is the key to avoiding medical debt. Afterall, you don’t want to be paying for services you don’t need or be paying for a health plan that doesn’t have nearly enough coverage. Every plan has different costs as well, so comparing prices is essential. Two companies can offer the same exact plan, but the prices can vary between a hundred dollars.

Understanding your health insurance plan

Now that you’ve selected a health plan that you feel is best for you, get to know it. Read over your welcome packet, take note of what services are covered, which ones aren’t, and which ones are free. Every health plan will have some basic health services that are covered even before you meet your deductible. Knowing what benefits you have can keep you from suddenly getting a medical bill for a service you assumed was covered. Some plans will only cover certain types of testing, or certain doctors. Make sure you know which is which.

Look at savings account options

If you choose a high deductible health plan (HDHP) you can actually also link a health savings account (HSA) to it. You can contribute money into your HSA tax-free. When you use the funds for qualifying medical expenses you can also withdraw the money tax free. This account can help you make sure you have money put away specifically for medical needs such as copays, coinsurance, prescriptions etc. Not to mention, the money in the account will never be taxed, even if it builds interest or if you invest it. That makes these accounts triple tax advantaged which is a benefit you can’t really beat.

How To Handle Medical Debt

Now, we know that you can’t always avoid medical debt, and tips to avoid medical debt aren’t helpful if you’ve already got some. So let’s look at what to do if you already have some medical bills piled up. Don’t worry, there’s steps you can take before trying to find a second job or declaring bankruptcy. You have a few options here.

Make Sure the Charges Are Correct.

Errors happen, even in billing departments. Billing departments deal with a lot of data and it’s shockingly common for medical bills to have errors. In fact, 8 out of 10 hospital bills have errors. Your invoice should be itemized, with each service and its cost listed separately. If it’s not itemized you can request one from the billing department. Check your bill for possible mistakes, like charges for services or medications you never got. For instance, if you have a bill for a hospital stay, make sure you weren’t charged for a full day’s room rate if you were discharged in the morning. There can also be typos or other errors. Look at each one and verify that each item is accurate. You can call the medical department if you have any questions or corrections.

Don’t Ignore The Bill.

Never, ever ignore those medical bills. It’s one of the worst things you can do, it guarantees that it will only get worse. The bill will go to collections and you’ll start receiving all those annoying collections phone calls and letters. This is where your credit score will take a hit, and the longer that debt sits there the worse it gets. We know it’s tempting to just “whoops” those bills into the trash but you’ll pay severely for it.

Don’t Pay It Off with A Credit Card.

It might seem like a good idea to use your credit card to pay off a medical bill. However, this is another big no-no. You’ll just be giving yourself more debt and might actually end up paying even more for the medical bill than originally had. Credit cards have high-interest payments, so carrying a balance on your credit card can lead to a never-ending cycle of debt. In turn, this can also lower your credit score. Unlike other debts, medical debts typically carry low to no interest. So, putting them on your credit card actually adds to the debt you have to pay.

Negotiate A Payment Plan.

Unlike other types of debt, there’s more wiggle room to negotiate payment plans for medical bills. Generally, as long as you’re paying something towards it they’re satisfied. You can even negotiate interest-free payment plans. Call the billing department and see if they’re willing to work with you, they’d rather get payments from you than go into collections. Even if they first suggest a payment plan that’s too expensive you can negotiate and talk them down to a more affordable number. This way they get paid and you avoid having this debt follow you for the next 7 years.

Dealing With Debt Collections

You know those unknown numbers that start calling and leaving voicemails and sending you letters about your bills being in collections? The last thing you want to do is deal with them, but you may have to. If the worst case scenario happens and your bills are turned over to a collection agency working with them is your best bet. It’s a lot easier to deal with internal collections, which are the ones that work at the hospital or doctor’s office. The internal collections departments are much more willing to negotiate payment plans, but we know more often than not, it ends up going to a third party collections agency. Here are a few suggestions to help make dealing with those agencies a little less painful.

Know What Debt Collectors Can Do.

Debt collectors actually aren’t allowed to call you an unreasonable amount of times, and they aren’t allowed to call at unreasonable hours like before 8am or after 9pm. Here are some of the debt collection rules.

- Debt collectors are not allowed to report your medical debt to credit bureaus if they’ve only had the account less than a year.
- If your medical debt is under $500 they can’t report them.
- If you’ve asked them not to call you at your job they are legally not allowed.
- They can’t threaten to sue you without a significant reason
- Debt collectors are not allowed to tell you that you’re committing a crime by not paying them
- They can’t threaten to tell others about your debt (except for your lawyer or spouse)
- Debt collectors cannot ignore your debt validation request either. If you send them a letter saying you want to verify that the debt is legitimate, they can’t contact you before responding to that letter.

Document Everything

Conversations with debt collectors can quickly get heated, but debt collectors are legally not allowed to harass or threaten you or use intimidating language. So, be sure to record all phone conversations with debt collectors. Once you reach a payment agreement, make sure you ask for it in writing. Don’t make any payments before you get the physical document stating exactly how much you have to pay. Then keep proof of payment. If your debt is ever questioned, you will be able to show that you paid the agreed amount.

Negotiate With Debt Collectors.

Obviously, debt collectors want full payment, but be firm and offer to pay what you can afford. They will likely agree. They will most likely have a counteroffer. Ultimately that’s their job- to get as much of this debt paid as possible. It looks better on your credit report if you can pay off the debt in full. But chances are you can’t. So, offer to pay what you can afford and don’t accept an offer that you won’t be able to meet.

Working With EZ

As we said in the beginning, avoiding medical debt is your best bet. And the best way to do that is to get the best health insurance plan for you. At EZ we can help you compare every plan available to you and find you the one that fits your needs and stays within your budget. We can actually save you hundreds of dollars a year by just choosing the right plan. To get started, enter your zip code into the bar below for your free instant quotes. Or give one of our licensed agents a call at 877-670-3557.

How To Meet Your Deductible

how to meet your deductible text overlaying image of a piggy bank and a stethoscope 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.

Copays

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.

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Find Health Insurance Plans In 3 Easy Steps

The Cost of Breast Reductions

Health Insurance Coverage

Steps To Getting Your Breast Reduction Covered

Meet with your PCP

Understand your benefits

Call your insurance company

Pre-authorization

Initial Rejection

Authorization

Is A Breast Reduction Ever Automatically Covered?

Working With EZ

Compare Health Plans Online

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Health Savings Accounts (HSAs)

How HSAs Work

Flexible Spending Accounts (FSAs)

How FSAs Work

Find Health Insurance Plans In 3 Easy Steps

The Differences

Qualifications

Annual contribution limits

Rollover rules

Changing contribution amounts

Keeping your account when changing jobs

Which Is Better?

Getting Help With EZ

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What Short Term Plans Cover

The Cost of Short-Term Plans

Short Term Plans State-by-State

Pros and Cons of Short-Term Plans

Pros

Cons

Qualifying for Short Term Health Insurance

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How to Buy Short Term Plans

FAQs

Will my doctor accept short term health insurance?

Are pre-existing conditions covered?

Is losing my short-term coverage considered a qualifying life event?

So, is a Short Term Plan the Best Option?

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What Most Health Insurance Plans Cover

What Health Plans May Not Cover

Travel vaccines

Acupuncture

IVF

Cosmetic surgery

Dental and vision

Weight-loss surgery

Hearing aids

Out-of-network doctors

Find Health Insurance Plans In 3 Easy Steps

How To Avoid Unexpected Medical Bills

1.Read, Read, Read!

2.Stay In-Network

3.Ask Your Questions

4.Compare Costs

5.Get Preauthorization

6.Expect The Unexpected

7.Document Everything

The Final Step Work With EZ

Compare Health Plans Online

Compare Health Plans Online

Avoiding Medical Debt

Compare plans

Understanding your health insurance plan

Look at savings account options

Find Health Insurance Plans In 3 Easy Steps

How To Handle Medical Debt

Make Sure the Charges Are Correct.

Don’t Ignore The Bill.

Don’t Pay It Off with A Credit Card.

Negotiate A Payment Plan.

Dealing With Debt Collections

Know What Debt Collectors Can Do.