Show notes
https://youtu.be/B-yvCmYotr8
Hey everybody, it's Matt Cavallo, from Situation Positive. It’s January and that means that your health insurance benefits have reset and you're going to start having out-of-pocket medical expenses again. Nobody likes those, so I'm going to teach you how to minimize the amount of money that you have to spend out of pocket for medical expenses each year.
Before I do that, I'm going to teach you a couple of common health insurance terms. The first definition is going to be deductible. Deductible is the amount of money that you have to spend out of pocket before insurance will kick in and start paying money for cover medical expenses. I'm just going to use nice round numbers. So, let's say you have a $1,000 deductible. You will have to pay $1,000 out of pocket for covered medical expenses before insurance will kick in and start to pay. So, the first thousand dollars goes towards that deductible.
Next is co-insurance. Often once you meet a deductible, you have what's called coinsurance. A lot insurance plans have an 80/20 split meaning that insurance pays 80% and you would pay 20%. For example, if there is a $100 charge and you have met your deductible, the insurance company would pay $80 and you would pay $20 for covered medical expenses.
First comes the deductible and next comes co-insurance, then finally you get to your max out of pocket. If you look at your health insurance plan benefits, you have a max out of pocket for in network and out of network services each year. So, let's say your max out of pocket is $2,000. When you meet your deductible, you have paid $1,000 of the total $2,000. Then, you have to pay co-insurance for each covered medical expense until you reach max out of pocket of $2,000. Once you reach your max out-of-pocket, insurance will pay for covered medical expenses at a 100%.
These terms are very important because what if I said we can get you to that max out of pocket without spending money from your own pocket? That means all of your covered medical expenses will be paid at a 100% by the insurance company and you could have $0 out of pocket expenses for the year. How can we do that?
I do it through planning. When you have a chronic illness, you can predict the number of medical visits, procedures and treatments that you have in a given year to manage your condition. For example, I have been living with a chronic illness for 15 years. At this point, I know everything I'm going to have to do to manage that chronic illness through the year:
Two infusions of my MS treatmentTwo neurologist appointmentsTwo labs for bloodworkTwo MRIs
I know the infusions are going to be my most expensive medical expense in any given year. Barring an unforeseen hospitalization, I can plan on my two IV treatments costing me the most money. Then I have blood work and MRIs, which I need those for my neurologist to monitor condition. Finally, I have two checkup appointments a year with my neurologist to authorize my treatment and manage my MS. This means that I know each year that I will have 8 medical appointments just to manage my chronic illness. Since I know that I have these appointments, I can plan them so the most expensive happen first so I can reach these spending limits early in the year.
To accomplish this, I schedule my first IV treatment in January. This is critical for minimizing your out-of-pocket spending. I am going to teach you in another video that pharmaceutical companies also offer financial assistance programs and that money can go towards your deductible and out of pocket maximum. A lot of these financial assistance programs don't have any income qualifications, so many of us are spending money on our prescriptions without knowing th...
Hey everybody, it's Matt Cavallo, from Situation Positive. It’s January and that means that your health insurance benefits have reset and you're going to start having out-of-pocket medical expenses again. Nobody likes those, so I'm going to teach you how to minimize the amount of money that you have to spend out of pocket for medical expenses each year.
Before I do that, I'm going to teach you a couple of common health insurance terms. The first definition is going to be deductible. Deductible is the amount of money that you have to spend out of pocket before insurance will kick in and start paying money for cover medical expenses. I'm just going to use nice round numbers. So, let's say you have a $1,000 deductible. You will have to pay $1,000 out of pocket for covered medical expenses before insurance will kick in and start to pay. So, the first thousand dollars goes towards that deductible.
Next is co-insurance. Often once you meet a deductible, you have what's called coinsurance. A lot insurance plans have an 80/20 split meaning that insurance pays 80% and you would pay 20%. For example, if there is a $100 charge and you have met your deductible, the insurance company would pay $80 and you would pay $20 for covered medical expenses.
First comes the deductible and next comes co-insurance, then finally you get to your max out of pocket. If you look at your health insurance plan benefits, you have a max out of pocket for in network and out of network services each year. So, let's say your max out of pocket is $2,000. When you meet your deductible, you have paid $1,000 of the total $2,000. Then, you have to pay co-insurance for each covered medical expense until you reach max out of pocket of $2,000. Once you reach your max out-of-pocket, insurance will pay for covered medical expenses at a 100%.
These terms are very important because what if I said we can get you to that max out of pocket without spending money from your own pocket? That means all of your covered medical expenses will be paid at a 100% by the insurance company and you could have $0 out of pocket expenses for the year. How can we do that?
I do it through planning. When you have a chronic illness, you can predict the number of medical visits, procedures and treatments that you have in a given year to manage your condition. For example, I have been living with a chronic illness for 15 years. At this point, I know everything I'm going to have to do to manage that chronic illness through the year:
Two infusions of my MS treatmentTwo neurologist appointmentsTwo labs for bloodworkTwo MRIs
I know the infusions are going to be my most expensive medical expense in any given year. Barring an unforeseen hospitalization, I can plan on my two IV treatments costing me the most money. Then I have blood work and MRIs, which I need those for my neurologist to monitor condition. Finally, I have two checkup appointments a year with my neurologist to authorize my treatment and manage my MS. This means that I know each year that I will have 8 medical appointments just to manage my chronic illness. Since I know that I have these appointments, I can plan them so the most expensive happen first so I can reach these spending limits early in the year.
To accomplish this, I schedule my first IV treatment in January. This is critical for minimizing your out-of-pocket spending. I am going to teach you in another video that pharmaceutical companies also offer financial assistance programs and that money can go towards your deductible and out of pocket maximum. A lot of these financial assistance programs don't have any income qualifications, so many of us are spending money on our prescriptions without knowing th...
