How to Maximize End of Year Health Benefits

What is a deductible?

Deductible is the set amount that the insured individual must pay before insurance starts to cover services.

What is coinsurance?

Co-insurance refers to the percentage of the medical costs that the insured individual is responsible for after the insurance company has paid their portion. This commonly kicks in once the consumer’s deductible has been met. A typical co-insurance coverage percentage is 80 percent insurance and 20 percent individual.

What is out-of-pocket maximum?

This is the maximum amount of money the insured individual is responsible for, out-of-pocket, for health care. Once this has been met for the policy year, the individual’s insurance company will cover 100% of any medically necessary services and procedures.

What is the difference between HRA, HSA, and FSA?

HRA, Health Reimbursement Arrangement, is an employer-funded account to be used towards employee health care expenses. These plans are customized by the employer with their own unique policies.

HSA, Health Savings Account, is a tax-advantaged health savings account available to all taxpayers in the United States. The money contributed to this type of account is not dependent upon the benefit year and is the insured individual’s to keep indefinitely.

FSA, Flex Spending Account, is individually-funded and available through one’s employer. Generally, the funds are dependent on the benefit year and will be lost if not utilized.

DEDUCTIBLE HAS BEEN MET – What type of appointments would be beneficial?

Once a deductible has been met, appointments such as in-office procedures (mole removal, wart treatments, actinic keratosis, etc.) would leave the individual only responsible for the amount according to their co-insurance policy.

OUT-OF-POCKET MAXIMUM HAS BEEN MET – What type of appointments would be beneficial?

Once out-of-pocket maximum has been met, appointments including some office visits for full body skin exams, Mohs (micrographic skin cancer surgery), and common skin conditions (psoriasis, eczema, rashes, and acne) should be covered in its entirety according to individual’s health insurance coverage.

At Clarkston Dermatology, we strive for each patient to maximize their health benefits while receiving superior care.

The end of the year is approaching quickly – schedule your appointment today!

Call 248.620.3376 or Request an Appointment Online

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