Navigating your health insurance benefits can prove to be complicated and tedious for many patients. Unfortunately, this process is necessary for anyone looking to fully use their benefits. Fortunately, East Bridge Massage is here to answer your questions. Below, we look at the most common health insurance terms you will need to know in the new year.

Deductible: Perhaps the area of the most confusion when discussing health insurance is a deductible. This amount, which ranges from several hundred to several thousand depending on the plan, is what needs to be paid out-of-pocket prior to health insurance benefits taking effect. Deductibles typically reset at the beginning of the year, January 1st many times, meaning most patients will pay out-of-pocket for their care in the new year until they have met their deductible.

Copay: A copay is a fixed amount that your insurance plan designates to a certain service. For instance, an hour-long massage may have a copay of $30 the massage would be $30 regardless of how the massage is billed by the provider. Oftentimes when a copay applies, a deductible does not.

Co-Insurance: While similar to a copay in that this amount is what you pay at the time of service, it varies in that it is a percentage of the amount the amount the insurance pays the provider for the given service rather than a fixed amount. If a co-insurance is 25% and a doctor’s visit is $100, you would pay $25 for your visit.

Out-of-Pocket Maximum: An out-of-pocket maximum is the most you will pay within your plan year for covered services. One of the primary reasons people have health insurance is in case they face a costly illness or emergency. An out-of-pocket maximum is almost always in the thousands of dollars. Every time you pay for services out-of-pocket, many times including your copays and co-insurance, it chips away at this high amount. Most patients who have surgery, a traumatic accident, or give birth will reach their out-of-pocket maximum. After this amount is met, your insurance pays 100% for your covered services.

At East Bridge Massage in Portland, Oregon, we are health insurance experts who are here to answer your questions about how your plan may cover massage therapy. For more information, read our insurance page or send us your subscriber information to check your plan.