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Three biggest surprise expenses lurking in your medical plan

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Three biggest expenses not covered by your health insurance

Health care costs are an ongoing source of concern for many Americans. Virtually all medical insurance plans come with co-pays and large annual deductibles. Since 2010, deductibles have risen at least 67%, even for employer-sponsored plans.1 Many common procedures, tests, scans and even hospital stays remain the patient’s responsibility.2  

Advance knowledge is the best strategy

It’s important to know your coverage in advance when it comes to health-related expenses. Balancing medical expenses with other expenses by knowing what you may have to pay out of pocket for can make budget and financial planning easier.

Below are a few costs generally not covered by standard medical plans.

  • Ambulance Rides: If not classified as a true medical emergency, you may receive a bill for $400 to $1,200 or more, depending upon the in-ambulance treatments you receive.3 A prominent hospital describes a medical emergency – worthy of a 911 call and an ambulance – as signified by symptoms that include chest pains, severe bleeding, burns, paralysis, broken bones, choking, dizziness or shortness of breath.4  

  • Cancer Treatment: Based on 2016 figures from the American Cancer Society, American men have about a one-in-two chance of developing cancer during their lifetime, while for women it is one-in-three.5 The positive news is that many kinds of cancer are becoming more curable. However, conventional medical plans often don’t cover many of the true costs. These costs range from scans and tests to medication co-pays to radiation and chemotherapies. There are also non-medical expenses to consider, such as transportation, home help, or childcare. 

  • Hospital stays: Hospitalization can include charges for medical specialists, nurses, branded medications, extra time spent in the hospital room, and facility fees.7 It’s preferable to get pre-certified by your medical plan before going in for treatment, but you should also prepare for significant bills unless you can find other forms of insurance coverage. 

Strategies to avoid surprises

First, know your plan options and create room in your budget for the unexpected. Consider upping your Flexible Spending Account or Health Savings Account if you have one to help cover the costs.

In addition, many costs your medical plan won’t cover can be offset by supplementary insurances. Cancer insurance, critical illness insurance, accident insurance, and hospital indemnity insurance may be available through your workplace. Check with your benefits administrator to see whether you can opt in. For a few extra dollars a month, you may be able to head off a big source of financial uncertainty.

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1Aimee Picchi, “The Painful Rise of High-Deductible Health Insurance,” CBS News.com, Feb.28, 2016   

2 Jay Hancock, “Surprise! Some Job-Based Health Plans Don’t Cover Hospitalization,” National Public Radio (NPR), Jun. 18, 2015   

3 Lisa Zamosky, “Who pays for the ambulance?Los Angeles Times, Aug.25, 2013 
4  “What is a Medical Emergency?”, Wake Forest Baptist Health/Lexington Medical Center, May 2016 

5  “Life Risk of Developing or Dying from Cancer," American Cancer Society, Mar. 23, 2016 

6 Guardian, "Why Medical Insurance is Not Enough,” GuardianLife.com, Apr. 26, 2016

7 Geoff Williams, "5 Hidden Costs of Hospital Visits," U.S. News & World Report, Apr.8,2014