Improper Insurance Coverage Can Have Devastating Financial Repercussions
Have you secured health insurance coverage for the year yet? If you have, congratulations! You are among the over 297 million Americans who have some type of health insurance coverage. You have taken the first step in mitigating financial risk and giving yourself peace of mind. But, do you understand how your health insurance plan works? Does it have network restrictions that could leave you vulnerable while you’re on the road? What does it (or you!) pay for a specialist’s visit, urgent care visit, or ER visit?
Understanding your plan’s benefits is almost as important as having coverage itself. If you do not use your plan properly, you will be on the hook for outstanding medical bills, causing stress and major financial burden. As a licensed health insurance agent working with the RVer Insurance Exchange, it is my job to not only provide health insurance options, but to help RVers and travelers understand how the plan they are purchasing actually works.
Real Insurance Coverage Scenarios
In this article, I am posing a couple different medical scenarios and giving examples of how three different health plans would cover these events. Our protagonist is going to be Eustice, a healthy and active 50-year-old full-time RVer domiciled in Texas. The health plans I have selected to demonstrate are some of the main types of insurance coverage plans offered at RVer Insurance Exchange via RV Insurance Benefits. One will be a TX ACA policy purchased off healthcare.gov, one will be a short-term medical plan by United Healthcare, and the final plan will be a typical fixed-benefit plan we would choose for RVers. I’ve tried to make the plans similar in terms of deductible and term-length to fairly represent each option.
Coverage Scenario #1
Eustice is in Miami, FL for a little beach relaxation. Along with soaking in the salt air, bustling nightlife, and mouth-watering Cuban cuisine, he’s also managed to acquire an ear infection from a boogie-boarding misadventure. No bother, he’ll just run by a local urgent care center to get a prescription for some antibiotics. Those places are so easy- the biggest inconvenience will be missing Happy Hour!
ACA Plan – Blue Cross Blue Shield of Texas Blue Advantage Bronze HMO 204
Estimated premium for 50-year-old male: $563.07/month
Unfortunately, since Eustice is in Miami, he is outside of his plan’s network. Therefore, neither urgent care visits nor generic drugs are covered by his plan. He will have to pay for everything himself. According to Health Care Blue Book, a website designed to assist consumers in finding the fair price for medical procedures based on location; the fair price of an urgent care visit is $200 in Miami, FL. A quick Google search will back up that average urgent care costs are between $150-$200. Using GoodRX, his antibiotics cost $8.99. His plan will not cover any of the visit. Total out-of-pocket cost of visit: $208.99
Short-Term Plan – United Healthcare Short Term Medical Plus
Estimated premium for 50-year-old male: $701.04/month
This is a nationwide PPO plan, so it is easy for Eustice to find an in-network urgent care center close to his campground in Miami. His plan has a $50 copay for urgent care visits, and then a $25 copay for “tier 1” prescription drugs. The antibiotic he is prescribed falls into this category. Total out-of-pocket cost of visit: $75
Fixed-Benefit Plan – Gold RVer Insurance Plan
Estimated premium for 50-year-old male: $201.92/month PLUS OPTIONAL $194.12/month recommended ancillary catastrophic components
This plan is a nationwide PPO plan that additionally allows out-of-network visits to any urgent care center with no penalty. Eustice saves some time and goes to the most convenient urgent care center. His fixed-benefit plan pays $300 for a visit to urgent care and $20 for generic medications. According to the data provided in our first plan example, the total cost of his visit’s expenses are $208.99. Total out-of-pocket cost of visit: $0 and Eustice will receive a check in the mail for the excess benefits of $111.01
Coverage Scenario #2
Eustice is work camping in Tucson, AZ, and notices that a mole on his arm has grown rapidly. He must not be wearing enough sunscreen! He needs to go to the dermatologist at once. Another RVer recommends a great dermatologist down the street, and Eustice goes and gets the mole removed in-office. Problem solved!
ACA Plan – Blue Cross Blue Shield of Texas Blue Advantage Bronze HMO 204
Once again, Eustice is outside of his plan network. He decides to self-pay for services since there’s no point in using his insurance card as it is completely useless in this scenario. According to Healthcare Blue Book, the excision of a benign lesion is $325 in Tucson, AZ. The dermatologist also charges him for a new patient office visit, which is $137. Since he is outside of his HMO network, Eustice is required to pay for all the medical expenses he incurs. Total out-of-pocket cost of visit: $462
Short-Term Plan – United Healthcare Short Term Medical Plus
The dermatologist that Eustice goes to is a member of the UnitedHealthcare Choice network, so he is in-network again with this plan. He has not yet met his $5,000 deductible for the plan year, though, so he will be responsible for all the costs of this visit. They will go toward meeting his yearly deductible. Eustice does receive the PPO network discount, which cuts the typical cost of doctor visits by 52%. However, due to the lack of transparency in the healthcare system, it’s very difficult to determine what the actual cost of such a visit would be. At RV Insurance Benefits, we have found that frequently the PPO network discounts insurance provides brings the cost of services to slightly above what the doctor/provider would charge for a self-pay price. So again, we’re going to say the total out-of-pocket cost of the visit would be: $462
Fixed-Benefit Plan – Gold RVer Insurance Plan
Eustice is disheartened after educating himself a little bit about PPO network discounts. He wishes there was more price transparency in the healthcare system and decides going forward he is going to self-pay for all medical expenses because that is how he can get the best prices on services. Fortunately, his fixed-benefit plan will reimburse him for self-pay costs in addition to being a PPO plan. His Health Saver Plus plan pays $150 for a specialist visit, and $200 for surgery in a physician’s office (mole removal). Total out-of-pocket cost of visit: $112
Conclusion
If you found the above scenarios confusing and intimidating…take heart, you aren’t alone. That’s why at the RVer Insurance Exchange, we strive to provide an overview of how different health insurance plans operate and help RVers and travelers find the plan that works best for them. We also stress the importance of understanding the specifics of your plan and its benefits. Be like Eustice and grow informed! Get a free health insurance quote today!
