Understanding Your Insurance Coverage

Health insurance is something that can seem confusing if you haven't had it long or if your plan has recently changed. 

Understanding your insurance plan and what it covers can help you find the best care with the least out of pocket cost to you. It's also important to understand when your insurance plan "resets"- most often it is on January 1st.  

What is a copay?
A copay is the amount you must pay in portion towards a service, while your insurance plan covers the rest of the charges. Depending on your plan you will have different copay amounts for services like primary care visits, specialist visits, etc. 

What is a deductible? 
Deductibles are the amount you pay out of pocket for medical costs before your insurance plan begins paying for it. 
If you have a deductible that needs to be met, that amount will reset in the beginning of the year. 
For example, if you have a $2,000 deductible and have met $1,800 by December 31st, your deductible will go back to $2,000 on January 1st. 

Not every service will be required to go through your deductible so it's important to know what services you plan on getting before you arrive for your appointment. 

Some plans have high deductibles with low monthly premiums while others have lower deductibles with higher monthly premiums.

If you have a deductible, it's important to monitor your plan through your insurance provider portal or Explanation of Benefits that you receive in the mail. As you get closer to meeting your deductible, you may want to let your providers know.

What happens after you meet your deductible?
After you meet your deductible, your insurance plan will start paying for your services. You may still be responsible for a portion of those charges, called a "coinsurance". This is usually a set percentage that you pay. For example, if the service costs $100 and you have a 10% coinsurance, you will pay $10 per session after your deductible has been met. 
With some services, you will have a 0% coinsurance once your deductible has been met which means you will not have to pay anything for those specific services. 

Choosing the right plan
When choosing an insurance plan, it's important to consider what needs you may have that need coverage. Choosing a plan with good mental health coverage will help keep your session costs low. You should also check to see if there are any limitations to your mental health coverage.

You should also check with your employer to see if they offer an Employee Assistance Program or "EAP" that may offer a certain amount of psychotherapy sessions at no charge to you. 

What is Private Pay?
A Better Tomorrow Counseling Services offers a private pay fee for clients that may not have coverage through our practice or choose to not go through their insurance. You may choose this option if you have a high deductible plan and you don't anticipate meeting that deductible by the end of the year. 
If you choose the private pay option, none of your sessions will be billed through insurance. 

Sources:
https://sjra.com/end-of-year-reminder-insurance-deductible-resets