Are You Taking Full Advantage of Your Health Insurance Coverage?

Now is a good time to review health insurance policies to ensure you will get the most out of plan benefits, especially if you have already met the annual deductible.

Many insurance plans will cover most, if not all, costs for eligible medical procedures and treatments once an individual meets the deductible and out of pocket maximum, making the second half of the year an opportune time to schedule any necessary or elective medical procedures that may have been postponed to reduce out-of-pocket expenses.

We encourage everyone to take full advantage of the preventative care and medical services available through their health plans,” said Michael Curran, CEO of Commonwealth Health Regional Hospital of Scranton. “If you’re contributing toward your premium, it’s a ‘use it or lose it’ situation, so make sure to utilize all of the benefits you’re entitled to before the year ends and deductible and out-of-pocket payment responsibilities reset.”

For example, someone who has a $2,000 deductible and a $4,000 out-of-pocket maximum is responsible for paying for many medical expenses until they reach the $2,000 threshold. Once they pass this mark, the insurer begins paying a larger portion of the cost of services eligible through in-network providers. And when they reach the $4,000 out-of-pocket maximum, insurers will pay the total cost for eligible services.

Remember, monthly premium payments do not count towards deductibles, and in most cases, copays do not count either. And once a new policy year begins, both deductible and out-of-pocket maximum contributions return back to zero.

Dr. Rourke Decker, Family Medicine with Commonwealth Health Physician Network highlights another critical aspect of leveraging health insurance benefits: preventative care.

“Regardless of whether your health insurance is through an employer, the Marketplace, or Medicare, preventative care is generally covered—including annual wellness appointments and immunizations,” said Dr. Decker. “Many people skip an annual physical because they ‘feel’ healthy, but these appointments can reveal underlying issues that might not yet show symptoms, when they’re easier to treat.”

Key screenings, such as mammograms and colonoscopies, and elective surgeries, such as joint replacements and hysterectomies, may also be less expensive once you’ve reached your deductible. But, plan early since sometimes these services can be harder to schedule during the second half of the year as more people catch up on their healthcare needs. And, in the case of surgeries, there may be a process that takes time before the procedure can be scheduled.

To check off one or more of these procedures from your to-do list, request an appointment today with your primary care physician. You deserve the best care.

The Wright Center for Community Health Announces Open Enrollment Event to Assist with Applying for Health Insurance Coverage

Area residents buying health insurance on Pennie, the state’s marketplace exchange, will have more plans to choose from and may pay lower premiums this year thanks to pandemic relief efforts. In order to help community members understand benefits available to them, The Wright Center for Community Health will offer free, in-person assistance on Friday, Dec. 10 from 9 a.m. to 1 p.m. at its Scranton Practice, 501 S. Washington Ave.

Wright Center certified assisters will provide free advice on health care coverage and help people sign up for a plan that meets their needs through Pennie, the replacement for healthcare.gov as Pennsylvania’s official site for choosing health insurance plans. Enrollment is open through Jan. 15, 2022, though plans must be purchased by Dec. 31 for coverage to begin Jan. 1 of next year.

At the Dec. 10 event, Wright Center enrollment assisters will:

  • Explain benefit options;
  • Find the best plan to fit every budget, and
  • Check eligibility for financial assistance.

To schedule an appointment, call Kristen Welch, outreach and enrollment navigator at The Wright Center, at 570.209.3737 or email WelchK@thewrightcenter.org. Please include your full name and phone number. Attendees are asked to enter the event through the patient entrance of the Scranton practice, located on the parking lot side of the building, where an enrollment table will be set up inside the lobby.

The Wright Center’s enrollment assisters are trained to help people identify and enroll in trusted affordable health insurance coverage options, providing them with a financial safety net and greater access to care. The confidential face-to-face meeting will help people better understand their options and assist them in the enrollment process.

“We know there are many residents in our area who remain uninsured and may not be offered coverage through work. Health insurance coverage is a basic human right and enrollment events like ours provide answers to the community regarding affordable health care options,” said Welch.

Anyone who suddenly lost their employer-sponsored coverage or is currently not insured should contact The Wright Center’s Enrollment Department as soon as possible by calling 570.591.5253. These individuals might qualify for a special enrollment period.

The Wright Center is a Federally Qualified Health Center Look-Alike. All patients are provided access to health care regardless of their ability to pay. People who are not insured or lack adequate coverage might be eligible for the sliding fee discount program, which allows The Wright Center to reduce fees for eligible patients, depending on household income and family size. Visit thewrightcenter.org/sliding-fee-scale for more information.