In response to the
Affordable Care Act, otherwise known as “Obama Care,” many health insurance
companies have modified their available policies such that the burden of
payment for health care has shifted to the insured individual.
Medicare is now the best insurance you can have, so long as you also purchase a
Medicare supplement policy.
the other health insurance policies changed?
Answer: Yes. Since January 1, 2014, the price of most commercial health
insurance policies has increased, while coverage has markedly decreased.
Because of newly required deductibles and co-payments, most patients with
commercial health insurance policies will find themselves paying, out of
pocket, for a much larger percentage of their yearly doctor bills. For example,
some Affordable Care Act (“ACA”) insurance plans have a $2,500.00 dollar
individual deductible. The family deductibles are twice the individual amount,
for many “Obama Care” plans.
is a deductible?
deductible is the yearly monetary threshold after which an insurance company
pays your medical bills. If your deductible is $500 dollars, then the insurance
company will not pay for $500 dollars of medical bills that you receive, each
year. The deductible must be paid, out of pocket, by the patient, in addition
to any co-payments, before the insurance company assumes any responsibility.
is a co-payment?
co-payment is the amount you must pay, out of pocket, for each physician office
visit. The co-payment is never covered by insurance and your doctor is required
to collect the full co-payment at the time of each visit. A co-payment may be
as small as $5 dollars, or as large as $50 dollars, or more, depending on the
co-insurance policy pays a fixed percentage of the medical bill, after a
deductible (if any) and co-payment (if any) are paid. An example of co-insurance
is a Medicare supplemental insurance policy that pays 20% of the allowable
Medicare charge, after the yearly Medicare deductible is met.
there anything I can do to avoid high deductibles and co-payments?
You can select a high quality health insurance plan. Such a policy will cost
you more in monthly premiums, but will likely save you money, in the long run,
if you need any medical care during the year. The best insurance plans,
including some Obama Care plans, have no deductible.
has Waisbren Medicine adapted to these recent changes in health insurance
the time of each visit, we request payment of the co-payment and full payment
of any overdue balance, before a patient sees the doctor. In cases of financial
need, our billing service has been authorized to set up a payment plan.
I may be paying, out of pocket, for much of my outpatient care, should I simply
not bother buying health insurance, and just take my chances, with my health,
until I go on Medicare?
The Affordable Care Act requires everyone to carry health insurance. Commercial
health insurance policies, especially those with high deductibles, should be
viewed as “disaster insurance.” As such, commercial health insurance would
protect your family from the enormous bills that a hospitalization would
generate. It is not uncommon for a single hospital stay to generate a bill in
excess of $100,000.00 dollars. Without health insurance, a hospital would likely
put a lien on your home or attach your other assets in order to collect its
I have testing done at the hospital or at a hospital-owned clinic, would I save
Hospitals, and hospital-owned clinics, are allowed to charge a “facility fee”
in addition to the standard fee, for most diagnostic testing. The bill for a
test performed in a hospital clinic or in the hospital, itself, would be around
40% more than in a private office such as ours.
if I need diagnostic tests, but cannot afford them, even at Waisbren Medicine?
who cannot afford diagnostic testing are referred to Deborah Heart and Lung
Center, a New Jersey charity hospital, where such tests are provided without
charge to the patient.
if I cannot afford office visits at Waisbren Medicine?
who cannot afford to be seen at our office are referred to the Volunteers in
Medicine Clinic, where free outpatient care is available.
may I call if I have any questions about my insurance policy or my bill?
about your bill should be directed to our billing service. Questions about
insurance plans or our office policies should be directed to our office manager.