10 Quick Facts To Patient Advocacy

That Will Make A Difference In Your Health

1. Have your most recent insurance card available for each medical visit.

 

2. Know the difference if your plan is a PPO or HMO or POS, Medicare or Medicare Advantage (replacement) plan.

 

3. Be sure you are aware of your co-pay amounts which may vary for office visits, urgent care, ED (emergency department) and Specialists.

 

4. Be advised if your insurance carrier provides a new insurance card.  Your member ID# may change, along with your  benefits. Again this is why it’s very important you have your updated insurance at each visit to avoid unexpected out of pocket expenses.

 

5. If you purchase a Medicare Advantage Plan, this has now replaced your traditional (red, white & blue) Medicare card. You do not have both coverages.

 

6. Medicare Part “B”does not cover Rx’s (prescriptions). Medicare Part “D” covers this benefit if which a deductible may apply.

 

7. What is a deductible?  This is a specified dollar amount that you (the insured) must pay before an insurance company will pay a claim.

 

8.  What is a co-payment?  This is a fixed amount for a covered service, paid by a patient to the provider of service before services are rendered. 

 

 9.  What is co-insurance? A percentage of a medical charge that you pay, with the rest paid by your health insurance plan after your deductible has been met.  Example: If you have a 20% co-insurance, you pay 20% of each medical bill, and your health insurance will cover 80%.

 

10.  What is an out of pocket maximum?  The most you could have to pay in on year out of pocket, for your health care before your insurance carrier covers 100% of the bill.

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