Experts recommend having health insurance to avoid financial setbacks. And, this is true: health insurance in San Antonio makes more money available to you while allowing you to get better health care services, vs. being uninsured.

But this basic suggestion ignores a serious problem: Many individuals with the best health insurance in San Antonio, TX still get stuck in medical debt. A recent survey indicated that around one-fifth of U.S. households couldn’t be able to pay for medical care services immediately.

What is “Great” Health Insurance?

What makes a health insurance plan great? Well, there is no definitive answer to this question.

A great health insurance plan for you may not be the best health insurance in San Antonio, TX for your friend or colleague. You might be living with a chronic condition, for instance, that could make a plan with a low deductible, 90/10 coinsurance, and broad network worth paying high monthly premiums.

On the other hand, your colleague might be a fitness enthusiast, who hasn’t gotten quite sick in the last five years. So, their ideal plan is the one that has very low monthly premiums and offers catastrophic coverage should they be diagnosed with a serious illness.

If we assume you have an excellent health plan, how might you end up incurring hefty medical debt?

Charging Medical Expenses to Credit Cards

According to a survey on bankruptcy filers in the U.S., more than 58% of the participants thought that health expenses were a contributing factor to their bankruptcy. High credit card interest rates may cause medical debt to multiply quickly while making it tougher to pay off.

Passing over Checkups and Skimping

Due to exorbitant rates, together with busy schedules and a usual aversion to hospitals and doctors, many individuals tend to skimp on health care. They don’t take their prescription medications, eventually failing to get better or keep a chronic disorder under control. They ignore annual checkups and fail to detect health issues when they are manageable or inexpensive to treat. These people often end up with a greater, unignorable problem and are stuck paying colossal medical bills.

Getting a Serious Diagnosis

The positive diagnosis of a serious medical condition may be just the start of your difficulties. Let’s presume that you are 28 years old and have a plan with $7,050 annual deductible – the highest deductible allowed for a high-deductible health insurance plan in 2022.

Now, once you start receiving bills for prescriptions, screenings, doctor’s visits, and treatments, the first $7,050 of those bills you will pay out of your pocket.

Your yearly out-of-pocket maximum is also $7,050 for marketplace health plans in 2022. In case you have a family policy, the out-of-pocket maximum would be $14,100, which is less manageable. Or, should you have an employer plan, your limits may vary.

Your treatment will possibly not fall clearly in one calendar year. When the next year starts, you will have to pay that deductible as well as the out-of-pocket maximum all over again. At that point, switching to a lower-deductible health plan might help, but it would be counterbalanced to some extent by the higher premiums you would pay for that plan.

Paying Hidden Expenses

As mentioned earlier, yearly out-of-pocket maximums can keep your health expenses low in a given year, particularly when you require a lot of care. However, out-of-network maximums may be substantially greater than in-network ones. To be precise, the out-of-pocket maximum for out-of-network services can be almost double of the out-of-pocket maximum for in-network services.

So, try as much as you can to ensure that you only get in-network care, as you may easily be slipped an out-of-network bill. For instance, you underwent surgery at a local in-network hospital, but received a bill from an out-of-network co-surgeon. Likewise, you visited your in-network primary care physician, but obtained an out-of-network bill from the laboratory your in-network provider used for your blood exam. There is also a possibility that you have a specific disorder and require seeing an out-of-network specialist.

If you are struggling with hefty bills you were not anticipating, a medical-billing advocate may come in handy.

Also, remember that many plans restrict the number of physical therapy sessions in a calendar year. However, your doctor may prescribe more than that for you to recover fully. So, any sessions beyond that restricted number will require you to pay out of your pocket.

There is another type of hidden costs which we often overlook: If you require frequent treatments for a specific condition, your transportation costs may add up. The costs of caring for a child may rise, and your earnings may decrease should your illness affect your working capabilities. If you are responsible to care for an elderly parent, you may need to pay a caregiver to care for them. You might also need to hire someone to care for you. If you are too weary to prepare meals on your own, your food expenses might shoot up. Likewise, if you don’t have time or energy to clean, you might require hiring a domestic help.

Besides, other potential hidden expenses may include lodging, travel to specialty care facilities, and lost income for a supporting partner or spouse.

Final Words

These are only some of the common reasons why individuals with the best health insurance in San Antonio, TX incur medical debt. Rejected claims, non-formulary drugs, chronic disorders, cost discrepancies from one health care facility to another, and the colossal rates of COBRA premiums, when you lose your job, may also contribute.

If you are determined to stay away from debt, know that even the best plan will not cover everything. This particularly holds true in cases of medical emergencies. Having said that, the best thing policyholders can do is to be well-informed consumers and take care of themselves.

As educated policyholders, they will know what questions they need to ask and how to get a plan with the highest quality care at the lowest price possible. By taking care of yourself, not only can you lower the extent of healthcare required over your lifetime, but you will likely be able to reduce the severity significantly should you need care.