Medical Expenses & Health Insurance: How to Understand It and Pay for It

After a recent Emergency Room trip with one of my kids, I felt a common fear among parents: how much is this going to cost? I know I made the right decision to go in, but it got me thinking. Having to worry about medical bills on top of all the other stresses of motherhood is just something we need to eliminate. I wanted to help my fellow moms with this since none of us know what medical expenses we are going to have in the future, so I compiled some resources below that may help you reduce some of that stress.

Do you understand your insurance?

If you have insurance through an employer you need to understand your coverage. Typically open enrollment for the next year is in the fall.  Make sure you know what is and isn’t covered. Questions to consider:

How much are your monthly premiums? Do you have deductibles or coinsurance? Do you have these per person or is it per household? Is there an out of pocket maximum per person or for the household? Are all your providers and pharmacies in network?  Do you have out of state coverage, virtual visit coverage, other specialty care coverage? Do you have a minimum charge for an Emergency Room visit and is that fee waived for any reason, like if you were admitted?

Do you qualify for Medicaid?

There are countless Medicaid programs and they all vary by state. These are in place to help their state residents with their medical bills, and many you can have as a secondary payor if you have other coverage.  Iowa has many programs (and this is NOT an all-inclusive list).

If you or your loved one is between the ages of 19-64, look into the Iowa Health and Wellness Program. If you are a U.S. Citizen, an Iowa Resident, and meet income guidelines, you may be eligible.

If you need coverage for someone under age 19, over age 65, is pregnant, disabled, blind or a parent/caregiver to minor children, you may be eligible for one of many of Iowa’s Medicaid programs if you meet their income and resource guidelines. Look here for more info and how to apply. Even if you think your income is too high, double check. There is a program called Hawki and many families are eligible to get coverage for their kids. If you currently have insurance through an employer, see if you may get help with the costs of your monthly premiums through HIPP.

There are many other programs available through Medicaid, so please reach out to your local DHS office or do more research here.

What is the Federal Marketplace?

If you don’t have coverage through an employer, it is too expensive, and you are not eligible for Medicaid, you can get coverage through The Federal Marketplace. Open enrollment is in the fall for the following year and you need to meet deadlines in order to purchase coverage. You may be able to get coverage outside of those time periods if you meet special enrollment requirements. Things vary by state so go to this website or call them directly to review. Be aware: not only will you have a monthly premium but also other out-of-pocket costs with services such as copays, coinsurance, and deductibles, so be sure to do your research!

Medical Expenses and Health Insurance Tips

What about Medicare?

Medicare is for folks over 65 or deemed disabled by Social Security. While this may not apply to you, if you have a loved one on Medicare you can share SHIIP‘s contact information as they are a free service for Iowans to assist with Medicare plan selections. Annual enrollment for the following year also begins in the fall, but if you are new to Medicare you will be given specific enrollment dates via mail.

What if I already have medical bills?

If you have medical bills, be sure you are reviewing them. Look at the explanation of benefits and make sure they charged you for services you did receive and see what your insurance paid. If it is all correct and you have concerns about paying for these, contact the hospital or clinic to ask them about their financial assistance programs. Many offer these charity programs that may include discounts or payment plans. Many folks are eligible and don’t take advantage, so contact them right away.

For the future: price compare. You can ask multiple clinics or hospitals what their estimated costs are for services, what financial assistance programs they offer, and ask your insurance if one would be cheaper than the other. This can be a bit tricky so take good notes. It may be cheaper at one clinic but they may not offer any payment or financial assistance programs whereas the other clinic may be a little more expensive but offer you a discount based on your income and offer payment plans.

Is there help for expensive medications?

Check Needy Meds, a non-profit resource helping people locate assistance programs for their medications. You can also ask the provider prescribing you the medication, your health insurance customer service line, or your pharmacist if they know of any assistance programs, generics, or other alternatives that would bring down your out-of-pocket costs.

What tax deductions or savings accounts are available?

Your best bet is to ask the person who does your taxes since they know your personal finances and expenses, but you can also read up on it here and here. Check with your HR as well, as you may be eligible to open a health care spending account through your employer.

Final tips:

Look within your local community and see what is available. Here in Iowa City we have a Free Medical Clinic and the College of Dentistry that both offer heavily discounted services.

Stay off google. If you try to find these resources yourself, you often may get tricked into buying a cheap monthly health insurance plan that is considered limited benefits, AKA: doesn’t pay for anything so it is essentially like going without coverage. Use the links in this post or ask people you know for specific contact information.

What money saving tips do you have on medical bills?

Megan
Megan, an Iowa native from West Branch, shares her home with husband Cody, two adorable kiddos Charlie and Gwen and their pet dust bunnies. When she is not smooching on them she is trying to change lives as a social worker. You can find her running endless errands in Liza the mini(van) or on a hot date with her treadmill watching IPTV. Since having baby #2 she is drowning in laundry and love and someday hopes to foster or adopt if fate will allow.

1 COMMENT

  1. Check your medical bills for errors! I think about half of ours contain errors. I have to call the medical provider and or insurance to fix the issue.

    If you don’t understand something on your bill or EOB, call and ask! Keep asking until you understand.

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