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health insurance hmo cardMost people understand the value that health insurance provides, but individuals who rarely visit a doctor may question the need to carry coverage.


Despite costs and complexity that seem to rise each year, health insurance greatly reduces financial risk related to medical care. Even for healthy people, an accident or sudden illness can lead to significant medical bills.


Most health insurance plans also guarantee access to preventive care that can help keep you healthy. Annual checkups, colonoscopies and other important screenings typically are among the preventive care services covered under most plans.


We’ve compiled some of the most common health insurance questions and answers to help you understand your coverage.

What Type of Health Insurance Do I Have?

Health insurance is available in two primary types. Health maintenance plans offer lower costs but sometimes limit the doctors and other medical professionals you can see. If you choose an HMO plan, you’ll select a primary doctor and will need referrals to visit other specialists.


Preferred provider organizations, or PPOs, are the most-used type of plans. You won’t need to select a primary doctor or get referrals, but you’ll pay more.


Other types of plans exist, but most people are covered under HMOs and PPOs.

What Are Deductibles, Copayments and Coinsurance?

These three terms refer to the covered costs for which your plan pays. Your deductible is the amount you’ll pay for certain services before your plan coverage kicks in. Regardless of meeting your deductible, you’ll pay a specified, usually minimal copayment for each medical service you receive.


Coinsurance refers to the percentage of your total medical costs you’ll pay once you meet your deductible. In addition, the out-of-pocket maximum refers to the highest total costs you may pay in a year.

How Do High-Deductible Plans Work?

High-deductible health plans generally work well for healthy people who need minimal medical care. If you have this type of plan, you’ll pay less in monthly premiums, but you may pay a significantly higher deductible should you have a serious accident or illness for which you need care.


High-deductible plans often cover preventive care such as regular checkups and certain screenings that are not included in the deductible. Many people set up a health savings account, or HSA, to use in conjunction with a high-deductible health plan.

Can I Get Coverage Through Medicare or Medicaid?

Medicare is the government health insurance program for people age 65 and older; it’s important to enroll as soon as you’re eligible. Through Medicare, you’ll receive hospital insurance at no cost, medical insurance for a monthly premium, and prescription drug coverage.


Medicare Advantage Plans replace traditional Medicare coverage and limit the annual maximum you may pay for your medical services. After you reach the limit on out-of-pocket costs, you pay nothing additional.


Medicaid is a federal health coverage plan for families and individuals with limited incomes. If you cannot afford health insurance, you may be eligible for coverage under the Medicaid program. For more information, contact your county social services department.

Does My Plan Cover Colonoscopies?

Screening colonoscopies typically are performed on healthy individuals to detect possible colorectal polyps or colorectal cancer. Medicare and most private insurers cover such diagnostic services without charging you a co-pay or requiring that you meet your deductible first.


To learn more about our services, insurance coverage and financing options, please contact Northeast Digestive Health Center.


december deductible


Just like that another year is coming to an end. It’s December and before you settle down for the holidays, you need to make a list of to-do’s. Are doctor’s appointments on that list? Most insurance plans run on the calendar year, meaning that soon your deductible will reset to zero. If you have met, or almost met, your deductible it is smart to complete tests, screenings or procedures before the year ends. We’ve clarified some common health insurance questions and provided tips for calendar year deductibles.


What are deductibles?


Deductibles, copayments and coinsurance refer to the covered costs for which your health insurance plan pays. Your deductible is the amount you’ll pay for certain services before your plan coverage kicks in. Regardless of meeting your deductible, you’ll pay a specified, usually minimal copayment for each medical service you receive. Coinsurance refers to the percentage of total medical costs you will pay once your deductible is met.


Most insurance plans have deductibles that reset to $0 at the beginning of every calendar year. In order to maximize your health plan this year, scheduling appointments will help save money in the long run.


Almost there.


If you have met (or almost) met your deductible, scheduling appointments and completing tests is a good way to save money in the future. Why put off something until next year when your insurance company will start paying the claims after your deductible is met? Here are some examples of things to consider getting done before January:

  • Colonoscopy
  • Lab work
  • Diagnostic testing
  • Surgery
  • Outpatient surgery
  • Prescription refills


Not quite.


If you are not close to meeting your deductible it makes sense to delay health care expenses until after January 1st. Money spent now that will not put you above your deductible will essentially be lost after your plan resets in the new year.


If you find that every year you come close to meeting your deductible but never do, you may be tempted to find a plan with a lower deductible so that you can pay less out of pocket. However, be aware that premiums for lower-deductible plans might be higher than you would end up saving. It’s also important to note that qualified preventative services are covered at 100% and you will not need to pay anything out-of-pocket.


Navigating health insurance can be confusing, there are plenty of resources available to help guide you through everything you need to know.


At Northeast Digestive, your health and wellness is our main concern and we are here to help you live a healthier life. From heartburn to colonoscopies, our team is dedicated to helping solve your digestive issues. We provide a full range of services and procedures to diagnose and treat a variety of digestive conditions and diseases. We participate in most of the insurance products from a wide range of insurance carriers and are happy to answer any insurance questions you may have. Need to schedule an appointment? Visit our website or call (704)783-1840 for more information.



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Northeast Digestive Health Center
1070 Vinehaven Drive NE
Concord, North Carolina 28025
Phone: (704)783-1840
Fax: (704)783-1850
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