On Private Health Insurance Coverage & The Health Insurance Marketplace
FAQs tagged with “Cost-sharing”
- Are annual physicals for adults and children available without cost-sharing as part of the preventive service requirements?
- I evacuated from my area because of a natural disaster, and none of my doctors are close by. What are my options?
- I have a $2,000 deductible but I don’t understand how it works. Can I not get any care covered until I meet that amount?
- I heard not all plans have to meet all rules. How do I know if my plan has to comply?
- I know recommended preventive services are updated all the time. Must my insurance cover newly recommended preventive services without cost sharing?
- I need a hip replacement and when I asked my insurer about coverage, I was told that my plan uses reference pricing. What is that?
- I notice Marketplace plans are labeled “bronze,” “silver,” “gold,” and “platinum.” What does that mean?
- I thought a colonoscopy screening was a free preventive service. When I went in for my screening, an abnormal growth or polyp was found and removed. I just received a bill for the removal of the growth. What can I do?
- I thought that contraceptives were now covered, but I heard on the news that some employers don’t have to cover them. Is that true?
- I thought there was a cap on out-of-pocket costs but my prescription drug benefit requires me to pay co-pays even after I’ve met the out-of-pocket limit for other medical benefits. Is that allowed?
- I thought there was an annual cap on my out-of-pocket costs, but I’m getting billed for something that puts me well above the limit. How can that be?
- I was in the hospital when my coverage changed from my old plan to my new, Marketplace plan. My provider during that episode of treatment is no longer in my plan’s network and I’m worried I’ll face higher cost-sharing as a result. Is this allowed?
- I went for a preventive screening colonoscopy and received a bill for the anesthesia used during my procedure as well as for the pathology exam to examine the polyp that the doctor found. Is this allowed?
- I went to my doctor’s office for a flu shot, but was charged for an office visit. I thought preventive services were covered without co-pays. How can that be?
- One of the reasons I chose my health plan was because my prescription drugs are covered. Can my health plan make changes to what is covered once I’ve enrolled, and how will I know ahead of time?
- There’s a co-pay for my brand name birth control pills, but not for the generic brand. I thought birth control bills had to be covered without any cost-sharing, is this allowed?
- What is a Catastrophic Health Plan?
- When I went to the pharmacy to get my birth control, I had a co-pay. I thought all contraceptive coverage had to be free?