Top 10 Health Insurance Myths

Myth 1:  I need to pay my deductible before my coverage kicks in.

Not true for all services.  If you have a copay for Doctor and/or Specialist visits, your copay works prior to having to meet your deductible.

Myth 2:  As long as my Doctor accepts my insurance carrier, I am in-network.

Not always.  Sometimes Doctors take only certain networks within an array of carrier networks.  You need to check to make sure your Doctor takes the specific network of your plan.

Myth 3:  I am covered wherever I go.

Not all health insurance carriers offer worldwide coverage.  Most only give you coverage for emergencies out of network inside the US, Canada and Mexico.  So, if you travel overseas, you might want to pick up some travel insurance to be safe.

Myth 4:  My copay covers all my services when I go to the Doctor or Specialist.

Copays only cover the Doctor or Specialist’s fee.  If there are tests run or services rendered outside the scope of a history and exam, like setting a cast, you can be billed above and beyond your copay.  Some services are subject to your yearly deductible.

Myth 5:  My private insurance states I have a copay of $100 for ER visits.

Read carefully.  Most ER visits are subject to your deductible.  The $75 or $100 amount you see is actually an “access fee” just for being in the ER.  After the fee is paid, your services will be billed toward your deductible.  This access fee is generally waived if admitted to the hospital.

Myth 6:  I just pay a copay for generics and brand name

Often times, for brand name drugs, carriers ask you to pay a pharmacy deductible first, for example, $500 or $1,500.  So, before your brand name copay kicks in, you need to satisfy this deductible.  This adds to your total out of pocket expense.

Myth 7:  As long as I stay healthy and don’t use my insurance, my rates stay the same.

No.  Every year carriers submit rate increase requests to your states’ department of insurance.  They are granted rate increases due to many factors, mostly due to rising cost of healthcare.  You also receive a rate increase based on your new and older age.

Myth 8:  If I am on a group plan and move to a private plan, I can’t be denied.

False.  The way underwriting goes, if you have a declinable condition, the simple fact of replacing a plan won’t give you 100% chance of being approved on a private plan.  You will be underwritten just like anyone else.

Myth 9:  I haven’t had insurance for years.  I will be covered for everything once I am approved.

If you are not replacing creditable coverage and have a pre-existing condition, you will have to wait for 12 months on most carriers before your pre-existing condition will be approved.  Having prior coverage helps you by making the carriers waive certain pre-existing waiting periods.

Myth 10:  Now that I have insurance, I can get that surgery.

False.  You can’t apply for coverage if you know you have an upcoming test, surgery or any known and needed medical treatment.  You must wait until you take care of this before you can apply for coverage.

Well, there you have it.  10 common health insurance myths.  To find out more about health insurance plans, contact me at 352-200-2066 or fill out my health insurance contact form.  I can answer all your questions and help you with a suitable plan.

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