Five Things to Remember About Your Health Insurance for 2016 Health insurance can be confusing, and no one wants to be stuck with an unexpected bill or unplanned expenses. Words like “coinsurance,” “copay,” “deductible” and “premium” don’t make things any clearer. You may have noticed the recent trends of higher health insurance premiums, higher deductibles, and decreasing coverage of services/medications. At Raleigh Capitol Ear, Nose, and Throat, we’re also aware of these uncontrollable changes in health care, and we understand the increased pressure many patients are facing. Doctors’ offices have little control over the cost of their own services because these rates are frequently set by the insurance companies. We’re dedicated to providing any information we can to help patients better understand the multitude of changes that are taking place.

Before you schedule your medical appointments for the year or visit a specialist, here are a five important things to remember about your insurance for 2016.

1. Be sure you’re covered.

First things first—you have to have health insurance, and you should have already signed up for a plan.

Under the Affordable Care Act (ACA), Americans who do not have health insurance will face penalties and fines. Information on the ACA can be found at  If you missed the deadline, you may still be able to purchase insurance if you changed jobs, moved to another state, or had a child. Having a good grasp on what type of plan you have or need will save you time and headaches later.


2. Has your deductible changed?

A deductible is how much you have to pay before your health insurance will cover the cost. For example, if you have a deductible of $3,000, that means that you'll have to pay $3,000 each year toward your health care costs before your health insurance will pay, although there are some exceptions. Preventative care services must be covered by your health insurance company, and some items may only require a copay.

If your deductible has changed, you may have to pay more out-of-pocket before your health insurance will begin to pay for the medical bills. The cost of deductibles can vary widely, depending upon your health insurance. Some may be as low as $2,000, while others may be more than $6,500. Don’t wait until you’re sick to find out what your deducible is. Learn now so you can plan and prepare for any medical expenses in the future.

3. Is your plan on a calendar year?

What this means is that your deductible “resets” each year on January first. This means that regardless of what you spent toward your deductible in 2015, that amount resets to zero at the beginning of the year. Here’s an example:

John has a $3,000 deductible for his health insurance plan. In 2015, he met that deductible—meaning he spent at least $3,000 out-of-pocket toward his health care expenses. Once he met that deductible, his insurance started paying for part of his services. In February 2016, John goes to the same doctor only to find that his bill is much higher. Why? Because the money he paid toward his deductible in 2015 does NOT count toward his deductible this year. He will have to spend $3,000 before his health insurance will pay for any medical expenses incurred in 2016.


4. What services are designated as “copay”?

A copay is the amount you pay for a particular service, regardless of whether or not you have met the deductible. What services have copays? This will depend upon the type of insurance you have. This should be marked clearly on your insurance card.


5. Know where to get information.

Most medical offices have employees who specialize in filing insurance. They can give you an idea of what your plan covers and how much you will be expected to pay. No one wants surprises when it comes to medical bills. Know who your health care insurance contact is at your medical office. If you have any questions about your billing or associated costs, ask before you have your procedure or visit. In addition, you can call your health insurance carrier for additional information. Often, they may be able to tell what the “bottom line” will be.

Everyone should have health insurance. But even the best insurance policy won’t help you if you don’t understand how to use it. Insurance is confusing, but the key to avoiding surprises is understanding what is covered, how much your deducible is, and where you can find additional information to help you.



United States Bureau of Labor. “Definitions of Health Insurance Terms.”