Picking the best time to schedule orthopedic surgery can be tricky, but there’s one factor that might help make the decision for you: whether you’ve met your deductible towards the end of the year. The end of the year is a great time to book those last-minute surgeries if you have met your deductible! Insurance benefits can be tough to understand, so we’re going to break down some of the terminologies to help you get the most out of your insurance plan and decide the optimal time to schedule your orthopedic procedures. Here are some key points about insurance benefits you’ll need to know.
Open Enrollment
This is a block of time (usually about a month) where you can sign up for a health insurance plan for the following year. Many organizations’ fiscal years begin in January, which means open enrollment often falls in November. Open enrollment is the time you can spend comparing and evaluating the different plans available to you so you can make a selection that is best for you.
Premium
This is the monthly cost of your insurance plan. Many people have this deducted from their paychecks so it’s not something you need to worry about each month. You pay this premium every month regardless of if you use your insurance plan or not.
Deductible
Your deductible is the dollar amount you are responsible for before your insurance company pays for anything. As you pay for services throughout the year, qualifying payments are tabulated until you reach the specified dollar amount. Once you reach that deductible amount, your insurance starts paying for a percentage of your services.
Many plans have a separate deductible for each person on your plan and a family deductible. Each person must meet their own deductible unless the family deductible is reached first. Meeting your deductible can be a key factor in selecting the best time to schedule orthopedic surgery.
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Coinsurance
Coinsurance is the percentage of costs you are responsible for after you meet your deductible. Your insurance company will pay a certain percent of the remaining bill, and you pay the rest.
Out-of-pocket maximum
This is the upper limit of how much a person can pay for medical costs billed to insurance each year. Once the total costs of your deductibles, copayments, and coinsurance reach this dollar amount, 100% of your covered services will be paid for by your insurance. Again, there can be an individual out-of-pocket maximum and a family out-of-pocket maximum.
If an individual reaches their out-of-pocket maximum amount, all of their future covered medical costs will be covered 100%, but not everyone else’s on the plan. But if the family out-of-pocket maximum is reached, then everyone’s future covered medical costs are paid for 100% by your insurance company. From a financial standpoint, this is the best time to schedule orthopedic surgery.
The Best Time to Schedule Orthopedic Surgery
Any time you have met your deductible is an excellent time to get any surgeries or procedures you might need. You will only need to pay the coinsurance amount and skip paying everything out-of-pocket to meet your deductible. Many people find that towards the end of the year, they have met or are close to meeting their deductible. If you are thinking about getting surgery or a procedure, now would be a great time to check your insurance benefits to see where you stand in terms of your deductible.
Orthopedic Treatment and Surgery Provider in Rockwall and Heath, TX.
Dr. Quinby of Quinby Orthopedics of Rockwall provides a wide range of orthopedic treatments for all ages of patients. Dr. Quinby performs non-operative treatments, minimally invasive procedures, joint replacements, and other orthopedic surgeries. Quinby Orthopedics of Rockwall will help you get seen right away and strive to schedule any procedures you might need in a timely manner to take full advantage of your insurance benefits. Call 469.929.0615 to schedule an appointment or send us a message here.
Need a visual? Here’s a sample cost breakdown of what it looks like when you meet your deductible!
