Insurance Annual Deductibles or Out of Pocket Maximums

What are annual deductibles and out of pocket maximums and what do they mean?

To get a better idea of these two terms its important to understand the overall generals of your insurance policy. When you purchase a health insurance policy, you will pay regular amounts to the insurance company, either through your employer or if you are self employed and have a policy, you pay directly to the insurance company. This policy will typically cover you (or your family) for 1 year and will require a renewal following that year.

Usually there are different tiered plans that are available for you (and family) to buy. The more expensive plans typically cover more, in the sense that the insurance company may pay more for medical services than you would. As an example, if a doctors visit cost $100, the insurance company may pay $100 or $90, leaving your $0 or $10 to pay.

A less expensive policy may only cover $50 of that $100 office visit, or require you to pay a deductible prior to the insurance company paying anything. The deductible is a dollar amount that the insurance company sets (lets say $1000 for this example), that they require YOU to pay over and above your premiums PRIOR to the insurance company paying anything for the doctors visit. So, going back to our example. If you have an insurance policy with a $1000 deductible and are going to see the doctor for a $100 visit, the insurance company would expect you to pay for the visit in total. They would expect you to pay for that and any other medical services until that $1000 deductible was paid. Following paying the $1000, the insurance company would then begin to pay a portion, or all of the remaining medical service expenses.

If your insurance company has an out of pocket maximum, this is the MAXIMUM amount they would require you to pay for any medical expenses. If you reach this amount your insurance company typically would pay 100% of the remaining medical expenses you accumulate for the remaining calendar year.

So, why is this information relevant? If you have paid your deductible or met your out of pocket maximum, medical services like physical therapy may be covered in full by your insurance company or at a reduced cost to you .

You can speak with your insurance company or ask a medical provider to assist you in finding this information. Knowing how your insurance policy works can better position you maximize your care.

Have you met your annual insurance deductible or out of pocket max medical expenses?  

If so, this may allow you to receive physical therapy care with no additional expense!
If you are having body pain, or need some help with improving your wellness, take this opportunity and contact equilibrium.

If you would like some help or an appointment, contact me.