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5 things you should know about health insurance before you get sick

By Margaux Austin | March 8, 2021 | 3 min read | Insurance Education, Simplifying Care, Tools and Services

Why am I paying this monthly fee for insurance? As a healthy 22-year-old fresh out of college, it was hard to digest the monthly cost for health insurance, or even to understand why I was paying for my few doctor’s visits out-of-pocket. When you’re healthy and your doctor’s visits are few and far between, it can be a hard pill to swallow.

But at 28, I was diagnosed with cancer. It didn’t take me long to understand the importance of health insurance.

I quickly began to understand the benefits my health insurance offered me. This past year, without health insurance, I would’ve had to pay over $500,000 for chemotherapy treatments, doctor’s visits and surgery. Not many people have that much money sitting in a savings account. I definitely don’t. Fortunately, I have health insurance and only had to pay my maximum out-of-pocket of $4,000.

Throughout the past three years, I have learned a lot about health care costs. I’ve also come to understand how to use my benefits to get the most bang for my buck. This way, I don’t have to worry about how I’m going to afford my care. That is stress no one needs when going through a health crisis.

Here are five things you should know about your plan before you get sick:

1. Understand your deductible.

Knowing your deductible and out-of-pocket maximum cost are first on my list. These two go hand-in-hand and will help you plan for your health care expenses. Your deductible is the amount you will pay toward covered medical services each year before insurance will start paying. You will always have to pay this amount, but it’s possible that you can go the whole year without meeting your deductible.

Every time you pay for care, the amount you pay is applied to your deductible. When you renew your health plan each year, the deductible and out-of-pocket maximum amounts reset.

2. Plan for your out-of-pocket maximum.

The amount you spend toward your deductible also counts toward your out-of-pocket limit or maximum. Your out-of-pocket limit is the most you will pay for care in a year. Once you hit your out-of-pocket limit, your insurance starts paying all costs for covered services.

In my situation, I know each year I am going to hit my deductible and out-of-pocket maximum pretty quickly (usually, before January even ends). I can plan for my health care costs by understanding that out-of-pocket maximum is the number I should save or be prepared to pay for health care costs in a given year.

Your copays (those fees you pay when you check out at the doctor’s office) don’t go toward paying down, satisfying or meeting your annual deductible. However, depending on your plan, copays may be covered once you’ve hit your maximum out-of-pocket.

Need more help understanding the lingo? Get clear definitions on the most used and misunderstood insurance words.

3. Find in-network providers.

An in-network provider, hospital or doctor is one that has contracted with your insurance plan. An out-of-network provider is a provider that does not contract with your insurance plan.

You will likely pay less for services if you use an in-network provider. For example, on my health plan, once I hit my deductible, I only have to pay 10% for an in-network visit. But for an out-of-network visit, I would have to pay 40% of the cost.

Our find a doctor tool can help you find a doctor or hospital that is in network for your plan. You can use this tool whether or not you are a member of Blue Cross and Blue Shield of North Carolina (Blue Cross NC).

4. Use Blue Connect.

For Blue Cross NC members, Blue Connect and its mobile app give you all the insurance information you need in once place. You can view your plan benefits and get your Member ID card all with a few clicks.

Blue Connect is where you want to go to find out what your deductible and out-of-pocket maximums are. It will also list each of your claims or health care visits. And it shows what you have paid toward your deductible and out-of-pocket maximum in real time. You can also connect with Customer Service through Blue Connect.

5. Know which preventive care services are covered.

Preventive care is routine health care like screenings, physicals and counseling to help prevent illness, disease or other health problems. It’s often covered by your plan because it can help you stay healthy and prevent a health problem before it starts.

Preventive care that is 100% covered includes many important services. See full list of preventive care services and any limitations for men, women and children.

You’ll want to take advantage of these covered services. But to make sure your care is covered at 100%, you need to visit an in-network doctor or facility.

Still have questions? Check out these resources we put together to help break down insurance basics.

Blue Cross and Blue Shield of North Carolina offers several decision support tools to aid you in making decisions around your health care experience. These tools are offered for your convenience and should be used only as reference tools. You should consult your own legal counsel, tax advisor or personal physician as applicable throughout your health care.

BLUE CROSS®, BLUE SHIELD®, the Cross and Shield symbols, and service marks are marks of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield plans.

These terms are defined to assist you in understanding some basic concepts of health insurance. Your health plan benefit booklet will further define these as well as other terms to assist you in understanding your selected policy.

These examples are provided for illustrative purposes only. Before you buy a plan, be sure to read all the details about your cost sharing responsibilities and how the provider network may impact those costs. Talk to an insurance professional to learn more.

BLUE CROSS®, BLUE SHIELD®, the Cross and Shield symbols, and service marks are marks of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield plans.