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    How To Navigate Health Insurance When You Have A Chronic Condition


    If you suffer from a chronic condition, managing your health may feel like a full time job. Insurance considerations can make it seem as if you are working overtime.

    It can be overwhelming to think about all the rules and codes that go along with prescription coverage and providers, as well as in-network and outside-of-network providers. How do you navigate it all? Can you calculate your monthly expenses and prepare for an emergency?

    Experts share their top tips for streamlining the process so that you can spend more time on improving your health.

    Learn about the medical network

    You may have a preferred doctor or specialist, and are looking for a plan that covers them. This is a great idea, but keep in mind that you may need additional specialists, particularly if your condition is progressive. Adrian Mak, CEO, AdvisorSmith is a consumer and business insurance company.

    He also suggests that you choose a preferred provider organization plan (PPO), which doesn’t require referrals from specialists if your plans include visits to new specialists. This will reduce the number of doctor visits and associated costs. A health maintenance organization (HMO), on the other hand, might require that you see a primary physician to refer you every time you visit a specialist.

    Mak says that it is important to compare plans by taking into account the out-of-pocket limit. This number shows you how much you will pay in-network for medical care in the course of a calendar year if you are enrolled in a healthcare plan.

    Find out more about your employer’s insurance

    Open enrollment will likely offer resources to assist with decision-making if you have employer-sponsored healthcare coverage. Brian Colburn is senior vice president of corporate strategy and corporate development at Alegeus, which is a technology provider that manages healthcare benefit accounts. He says that while employers can provide a wealth of information, many people do not take advantage of this opportunity.

    Colburn says that 63 percent of workers simply reenroll in their previous year’s plan after being unable to make the right benefits enrollment decisions. This can happen even if the worker’s health has changed due to a chronic condition.

    He suggests that you ask for all materials from your employer and take the time to read them.

    To understand your expenses , organize receipts

    It’s important to keep receipts for all healthcare-related expenses when calculating expenses. Brian Haney, founder and CEO of The Haney Company, a financial services company, said that even expenses you don’t pay through an HSA are worth considering.

    He suggests that you be honest about the ongoing medical treatment requirements when you calculate expenses. This means looking beyond the treatment you are currently receiving and focusing on what can be done to improve your overall health.

    He says that this could include expenses related to health and fitness. Include any activities that support your wellbeing in the calculation.


    Maximize your savings and spending options

    You may have an HSA or a flexible spending account (FSA) in addition to, or instead of, an HSA. The difference between an HSA and a flexible spending account (FSA) is that you have control over the funds in it. These funds can also be rolled over year after year. You can also keep your HSA money even if you move jobs.

    An FSA, on the other hand, is owned by the employer. The contribution limits are usually lower and the funds could expire at the end. If you change jobs, your FSA funds will be lost unless you continue to have COBRA coverage.

    Colburn says that no matter what type of insurance you have you can use these funds for out-of-pocket expenses not covered by your insurance. This could include copays for doctor visits, diagnostic tests and prescriptions.

    He adds that in an ideal world you would contribute as much to your HSA as possible to pay for medical expenses and save money for future care. However, reality is not always possible. This is a way that many people cannot afford.”

    According to him, the best thing is to contribute the amount that you believe you will spend on out-of pocket healthcare costs over the next year. This should be at least the deductible. This will allow you to reach your deductible tax-free.

    Colburn advises that even if you don’t have the money to do it, you shouldn’t let that stop you from doing as much as possible.

    Learn the rules for chronic illness coverage

    A type of insurance called chronic illness insurance pays a lump amount if you are diagnosed with an illness that renders you incapable of performing at least two of six daily activities for at least 90 consecutive days. This policy covers eating, bathing and dressing, as well as toileting, transferring and toileting. If you have severe cognitive impairment, you may also be eligible.

    Linda Chavez, the founder of Seniors Life Insurance Finder (an independent agency), says, “This insurance should not be replaced your basic health insurance. It’s considered a supplement to it.” It will also pay if the disease is confirmed. This insurance can be used to provide financial support for your family so that they are not affected by it.

    This coverage may not be applicable if you have a chronic condition. Chavez recommends that you check the details of any complementary insurance if you are concerned about being diagnosed as having another chronic condition.

    Search for wellness benefits

    Haney suggests that you look deeper into benefits and perks related to wellness in both your employer’s offerings and your insurance plan. These benefits are not often promoted but can improve your health. You could be eligible for a low-cost or free gym membership, a cooking class, or telehealth sessions with a mental therapist.

    He says, “Look beyond the insurance that is available for managing your condition to see what you can do for yourself overall.” “Ultimately, all of us must be our greatest advocates for taking care of ourselves financially and physically.”

    Tips to get the best out of your insurance policy

    Here are some tips to help you choose the right plan for you.

    • You should look for a plan which includes the doctors and specialists that you are currently seeing. To find out if a particular doctor is covered by your insurance, you can call them. The office of your doctor can tell you which insurance companies they work with. They will also inform you if the insurance company bills directly. If they do, you will need to pay first before the insurance provider reimburses you.
    • Add the out-of pocket maximum to the monthly premiums. This will give you an idea of the maximum you can expect to pay for a year. If the monthly premium, the amount you pay each month into the plan, is significantly lower than the one with the higher out-of pocket maximum, it may be more expensive overall. You should also pay attention to the deductible that covers hospital stays, specialist visits, and office visits.
    • Check out the list of covered services. Find out how much coverage is available for a particular treatment or procedure if you are certain you will need it.
    • Check the coverage for drugs. Many insurance policies offer different coverage for brand-name and generic medications. These differences are important, especially if your current brand-name medication is covered.

    It’s important to review your insurance statements and medical bills regularly once you have a plan. It’s worth calling your insurance provider or the doctor who submitted the claim if you notice something is wrong or you feel you have been overcharged. Sometimes, an error in medical billing could lead to an overcharge.

    Before you undergo any costly procedures like an MRI, it is important to verify your coverage. Even if your doctor confirms coverage, you can still call your insurance provider to verify what’s covered. This can prevent you from unexpected bills.

    Contributing tax-free money into an HSA/FSA can make your dollar go further. FSA dollars cannot roll over so it is important to consider how much you will need to spend on your FSA in the next year.


    Insurance can save you thousands, or even hundreds of thousands, of dollars on medical expenses. To make the most out of your plan, be familiar with its coverage and medical network.

    If you have any questions regarding your coverage, please call the number at the back of your insurance card. They will be able to explain the details of your plan, as well as answer any questions regarding coverage or medical bills.



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