What Happens When Your Deductible Is Met?

Now that fall is in full swing, it leaves only a short amount of time to meet your insurance deductible. Want to get most out of your health insurance before we ring in the new year? Read our Insurance Deductible Guide to get the most out of your health insurance.

While you’re at it, take a quick glance at your health insurance deductible to see how much you’ve spent towards it.

Did you meet your deductible yet?

Once you reach your out-of-pocket deductible, you can get the most out of your health insurance if you schedule those remaining procedures by Dec 31. Check out our Insurance Deductible Guide for tips on saving money on healthcare. Learn how to make the most of your insurance coverage.

What is an insurance deductible?

Insurance deductibles are your out-of-pocket costs –paid by you before your insurance carrier pays the higher percentage of your healthcare expenses.

Simply put, once you meet your deductible, you pay less and they pay more. This is why we urge people to schedule those treatments, scans, and procedures they’ve put off all year—after meeting their deductible.

Keep in mind, when it comes to out-of-pocket costs, there are caveats. That’s why we reached out to Jennifer Kohlscheen, precertification supervisor with Gastroenterology of the Rockies.

“When your deductible has been met for the year, that does not necessarily mean your out- of- pocket cost has been met and insurance will cover in full,” Kohlscheen said.

“Most patients who have a deductible plan will also have a coinsurance (example 80/20 coverage). The patient is responsible for 20% of billed charges up to their out-of-pocket maximum. Once that is met, then insurance will cover at 100%,” she added.

Here’s a resource about deductibles and co-insurance in case you’d like to learn more.

Let’s dive in. Here’s a checklist to keep you on track and help you save on your medical expenses once your deductible is met.

 

Why Do Annual Exams Matter?

In case it slipped your mind earlier this year, remember to schedule an appointment with your primary care physician (PCP) for an annual exam.

Annual exams are usually covered as routine preventive care –but not always. It’s best to check with your insurance carrier.  Many insurance companies cover this visit with little to no out-of-pocket expenses. Keep in mind, a “health plan” and health insurance is different. Health plans or supplemental plans have different rules about coverage and fees.

Always check with your insurance carrier to find out how annual check-ups are covered and billed.

Why do annual check-ups matter? Because your PCP can help you determine whether you might need to see a specialist. By ordering routine lab tests or bloodwork and checking your vital signs, like blood pressure, they can quickly assess your health. If they see something out of the ordinary, they might refer you to a specialist they know and trust.

These specialists include cardiologists, gastroenterologists, OB-Gyns–or dermatologists for annual skin checks that detect melanoma or skin cancer.

Preventive Screenings Matter

Keep in mind, when you schedule preventive screenings, they are generally covered by your insurance company with little or no out-of-pocket costs. However, if the screening reveals the need for a follow-up procedure, treatment or you develop symptoms, these follow up tests and treatments would be covered at a higher percentage once your deductible is met.

Breast Cancer Screenings For Early Detection

October marks Breast Cancer Awareness month.  Woman between age 40 to 54 –are encouraged to schedule routine yearly mammograms,
according to the guidelines from the American Cancer Society.  These guidelines also suggest that women 55 years and older can continue with yearly screenings—or change to every other year.

Screenings can help detect abnormalities hidden to the human eye. Even if you are diligent with monthly breast self-exams to check for lumps, mammograms help your doctor see what you cannot see or feel. Early detection is the best way to prevent breast cancer, and for other cancers too.

 

When Do  I Need My Colonoscopy Screening?

If you’re at least 45 years of age, it’s time to schedule a colonoscopy screening, according to guidelines from the American College of Gastroenterology.  People with family history of colon cancer may be eligible for screenings before age 45.

Either way, try to schedule your appointment now because it can take several weeks or months before a gastroenterologist can see you. Depending where you live, especially in rural communities, specialists can be hard to find or may have a waitlist.

Even if you don’t have symptoms, don’t wait to schedule a colonoscopy screening or follow up colonoscopy. Because sometimes there are no GI symptoms, despite the presence of colon polyps—which are abnormal cells in the colon. Some polyps may progress – while others could be benign or harmless.

Explore our colon cancer prevention page to learn more about colon cancer symptoms, treatments and detection rates among different screening options.

Time to Refill Prescription Medications

Once your out-of-pocket deductible is met, try to fill any remaining prescriptions. Mail-in and retail pharmacies can fill 90-day prescriptions as long as your doctor writes it up as a 90-day supply.

Injection Therapy Savings

Injections for osteoporosis, knee pain (orthobiologic injections) or B12 shots can be costly. But you may find the prices are more manageable after your deductible is met. It’s worth asking your insurance company.

Like any coverage, it’s important to ask if there is a limit on how many injections are covered each year. You should also find out which medications or therapies are not covered.

Plan for Elective Surgery

Once you fulfill your insurance deductible, consider scheduling any elective surgeries you may want or need. People often plan some common elective surgeries towards the end of the year once they meet their deductible.

• Eye Surgery
• Hernia Surgery
• Anti-Reflux Surgery
• Joint Replacement
• Meniscus (knee)

Physical Therapy Appointments

On-going physical therapy appointments may be covered once your deductible is met, depending on several factors. If your plan has a cap on the number of appointments per year, it may present a challenge, but if not, you may be in luck. And this could save you some money. So always ask your insurer just to be on the safe side.

Medical Device Replacement

• Infusion Supplies or Pumps
• CPAP Machine
• Blood Sugar Monitor

Check with your insurance company to see how your coverage handles medical devices once your deductible has been met.

 

We hope you find this Insurance Deductible Guide helpful. Have questions about screenings or treatments for digestive conditions? Call us at 303-604-5000.

 

Produced by Elise Oberliesen, reviewed by Emily Marshall, PA-C and Jennifer Kolscheen.