Health Insurance Co-Payment Increases

Some health services bring great benefits to patients. Physical therapy is one of them. During a patient's hospital stay after surgery or injury, physical therapy is often the first step toward a person's road to recovery. Once they go home, therapy continues to aid the patient's full recovery. But some health insurance companies are raising the co-payment rates for outpatient physical therapy services and freezing out its policy holders from getting the care they need.

Once a patient is discharged home from the hospital, they may require additional physical therapy to make sure they recover safely and correctly. The goal is to return the person to their prior level of activity (or better) before the hospitalization and to make them as functionally independent as possible. The therapy may take place in an outpatient setting or in the patient's home, depending on the patient's level of activity and mobility.

For instance, many patients who have a total knee replacement surgery require several physical therapy sessions after hospital discharge to help increase knee range of motion (bending and straightening) and strength. Without it, they never regain full mobility and flexibility.

Physical therapy has shown outcomes that reduce a patient's need for medications, imaging, injections and surgery. This saves the health insurance company more money in the long run.

In New York State, physical therapists have been classified as specialists by health insurance companies and therefore the co-payments have risen to specialist rates. It makes it impossible for some patients to afford the $50 or $60 or $70 co-payment 2-3 times a week. It seems like these companies are going to be losing more money in the long run when their patients have to return for additional medical care that could have been reduced or eliminated through the help of physical therapy. New York State physical therapists are going to Albany to fight for new laws that will reduce a patient's co-payments for services.

Before buying individual health insurance, make sure you read and understand all the benefits, deductibles, co-payments, and premiums that go along with the medical plan.

Do I Really Need Health Insurance?

Buying individual health insurance may be one of the smartest choices you make in your lifetime. Regardless of how healthy you are, you can never plan for an accident. A trip and fall can result in a broken bone. You may be a safe driver, but there are thousands of drivers on the road everyday who are distracted or impaired. It only takes a split second for one of them to plow into your vehicle and land you in the hospital. Even if you aren't seriously injured and you're lucky enough to be released from the emergency room the same day, you're looking at thousands of dollars in medical bills. The ambulance ride alone can cost several hundred dollars.

If you have children, the need for health insurance increases. Immunizations and childhood illnesses can be costly without coverage. It's not unusual for kids to break a bone or incur some other type of injury during play, especially if they're involved in organized sports.

Without health insurance coverage, people are reluctant to seek medical care when they are sick or injured. They feel they can get better on their own without paying to see a doctor. Eventually, their condition worsens and by they time they eventually seek medical help, they are much sicker than they would have been had they gone earlier. This can be especially dangerous for infants and children because their young systems can't fight off illnesses as well.

You don't have to spend a fortune when buying individual health insurance. Do your research and find a plan that suits the needs of you and your family.

What Are Health Insurance Deductibles?

When you begin your search for affordable medical coverage, you need to determine what your health insurance deductibles will be when you sign up for a plan.


What are Health Insurance Deductibles?

A deductible is the amount you must pay for medical services before your health insurance coverage takes effect (similar to car insurance deductibles). For instance, if your deductible is $1,000 for the year and you get a hospital bill for $4,000, you are responsible for paying the first $1,000 out of pocket and your insurance company will cover the rest. But you may also incur additional fees if your health plan includes you paying a percentage of all hospital stays. Many plans have an 80/20 arrangement. They pay 80% of "reasonable costs" and you pay the other 20%. Reasonable costs are determined by your insurance company. Deductibles can range from $1,000 to as high as $5,000. Usually, the higher your deductible, the lower your monthly premiums will be. Adversely, a lower deductible means higher premiums.

Deductibles are a way for insurance companies to offset their costs. That's why higher deductibles mean lower premiums for the policy holder.

Health insurance deductibles may vary within a policy. You may have a $1,000 deductible for surgery or hospital stays, but your deductible for prescription medications or physical therapy services may be much lower.


What Are Co-payments ?

Some health plans require a co-payment for a doctor visit, xray, MRI, prescriptions, hospital stays, and other various services. It can be as little as $5 or as much as $250, depending on the type of service, your monthly premiums, and the benefits of your plan. These fees are not associated with your deductible. Under most plans, you can't apply your co-payments to meet your deductible.

What Are Premiums?

Premiums are the monthly, quarterly, or annual fee you pay to remain insured under your health insurance policy. Usually, the lower your fees are the less coverage you will receive, or the higher your deductible will be.

How to Choose a Health Insurance Plan

First, determine what you are willing to pay. If you have a spouse and children you will end up paying more.

How much are the premiums, deductibles, and the co-payments?

Can you afford the deductibles? (the amount you have to pay before your insurance coverage takes effect)

If you take a lot of prescription medications, is there a high deductible or co-payment?

If you choose a PPO or POS, check their list of hospitals within the network to determine if they are acceptable to you.

There are many things to consider before buying individual health insurance. Compare benefits and options before making a decision.