Does Your Health Insurance Offer a Protective “Cap”?


     Information in this article could be extremely important to your financial well-being.  We all know that health care costs can be staggering.  The main reason to have major medical health insurance is to help protect you from an unexpected medical emergency, catastrophic illness, or expensive surgical procedure.  Bills of $10,000 – $30,000 are not unusual for such treatments.  However, what if you received bills from the hospital, surgeon, anesthesiologist, pathologist, radiologist, etc. which totaled $50,000 to $100,000 or more?  True major medical health insurance policies will have provisions to help even with the majority of these costs.  The following information will explain how major medical insurance functions.

     Your first responsibility will be to meet your health plan’s annual “deductible”.  This is a fixed amount that an individual has to pay before the insurance company covers its part of your bill.  After the deductible has been met, the insurance company will apply a percentage to the remaining bill.  This is called the “coinsurance”.  Coinsurance is expressed in terms of how much the insurance company pays compared to the insured, for example: 100/0, 80/20, 70/30, etc.

      Another very important factor to consider with your health insurance is your “maximum out-of-pocket” responsibility.  This will be clearly stated in your policy, and it represents the “cap” on the amount a patient will have to pay for treatment in a year.   Some policies indicate if this includes the deductible.  It does not include premiums or copays for office visits or prescription drugs.

     There are certain health insurance plans which provide coverage for some medical expenses, but do not define a limit to how much the insured may be responsible.  These may offer a somewhat discounted monthly premium for limited coverage, but they do not provide protection for what you need the most.  They do not have a “cap” (or limit) on the maximum financial responsibility of the insured

     Check your health insurance policy right away.  If it does not indicate an individual out-of-pocket maximum, then you probably have a limited-benefits health insurance plan, and not the financial protection of a true major medical health insurance plan!  These health plans usually indicate how much they will pay toward specific items like daily hospital stay, certain surgical expenses, emergency room treatment, prescription drugs, etc.  They tend to have an itemized list which describes the limit of what will be included for coverage.  This type of health plan can render an unexpected patient liable for the balance of a very expensive doctor/hospital bill!

     The cost of periodic office visits or generic prescriptions are affordable for most Americans.  Our main need when it comes to health insurance, is coverage for those major health setbacks that can be truly overwhelming financially.  We should have a major medical health insurance plan which provides us with a “maximum out-of-pocket” responsibility…a protective “cap” for those expensive bills!

     Contact AustinHealthPlans at (512) 535-3556 to receive more details about securing a true major medical health insurance policy.  We will provide you with answers to your questions, and find the right coverage for your needs and budget, at an affordable rate.  We have access to over 200 health insurance plans from many top-quality major insurers.  Thanks for reading our Blog, and we welcome your comments.  We appreciate your referrals if you liked what you read here!


About tcdiehl

I have been an independent insurance agent licensed in Texas since 2003. My focus is providing affordable insurance coverage through multiple reputable insurance providers for individuals, families, and small groups. I can also help with Medicare insurance needs. Allow me to connect you with the appropriate health, life, disability, long term care, and/or dental plan(s) based on your health, personal, and financial needs. Call me at (512) 535-3556, E-mail:
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