2. Treatment Abroad
3. Mental Health
Deductibles, co-pays and coinsurance. While these types of primary medical plan out-of-pocket costs aren’t necessarily surprising today, they can be challenging for business owners who have already sacrificed so much to get where they are.
But what you might not realize until you actually seek care are the other more hidden shortfalls. It can be frustrating to then find out that you need to pay out-of-pocket.
Let’s look at 5 common areas that can drive those surprises and what you can do about it.
1. Alternative Medicine
4. Perscriptions
5. Physical Therapy or Chiropractic Visit Limits
Alternative Medicine
Conventional medicine treats ailments after they arise, often focusing narrowly on specific areas of the body or conditions. Alternative medicine, on the other hand, targets the root cause, emphasizes prevention, and boosts the immune system with natural treatments like acupuncture, naturopathy, biofeedback and massage therapy. Despite increasing demand, employer-sponsored plans typically lack coverage for these non-traditional treatments.
Treatment Abroad
Employer-sponsored primary plans tend to offer limited international coverage, if they offer any at all. Some limit medical treatment to emergency and urgent care—others limit what countries they offer any coverage in (like only those that border the U.S.²). Keep in mind that international medical facilities are typically considered out of network. So, even if your primary plan covers medical treatment outside the U.S., you could still wind up paying the higher out-of-network charges.
Mental Health
In recent years, there’s been a notable rise in the demand for mental health and wellness support among employees across different industries. While your health plan probably provides some mental health coverage, providers are significantly more likely (five times more likely³) to be out-of-network making accessing treatment more challenging—and more costly.
0
%
of small employers and 62% of large employers said they will increase the number of benefits offered in the next five years.
(LIMRA-EY, 2023)
0
%
of SMB employees say offering a wider array of non-medical benefits would make them more loyal to their employer.
(METLIFE, 2021)
Prescriptions
Some primary plans require you to meet your in-network deductible first. This means paying the prescription’s full cost upfront until your deductible is met. Then you will pay your co pay or coinsurance amount until you meet your yearly out-of-pocket maximum.
Physical Therapy or Chiropractic Visit Limits
Physical therapy and chiropractic treatments often require numerous sessions for effectiveness. However, many primary plans limit the number of visits allowed per year, with some not covering chiropractic care at all. This can lead to frustration when you and your therapist recognize the need for more sessions, yet battling your health insurance plan for coverage proves futile.
Get the Coverage You Want: How to Reduce the Frustrations of Primary Plan Shortfalls
You have no doubt experienced some, if not all, of these primary plan limitations. What can you do to overcome those shortfalls and reach the peak of health and financial wellness for yourself, your family and key talent?