What Active People Should Consider When Buying Health Insurance WEB

Can You Afford a Broken Leg? What Active People Should Consider When Buying Health Insurance

So you’re healthy, active and don’t visit the doctor too often, does that mean a low premium, high deductible bronze plan will be the right fit for 2015? Maybe. But maybe not.

Whether you go for daily runs, race mountain bikes, play in a recreational basketball league, or enjoy downhill skiing with your family several times throughout the winter, you may want to factor in potential sports injuries when selecting health insurance coverage.

Each year, nearly 2 million otherwise healthy Americans suffer sports-related injuries that send them to the emergency room for treatment.[1]Among adults ages 25 to 40, the prevalence of injuries and most common by sport were as follows[2]:

  • Bicycling (126.5 injuries per 100,000 individuals) — head injuries (concussions and fractures) and shoulder fractures or dislocations
  • Basketball and soccer (61.2 injuries per 100,000 individuals and 23.8 injuries per 100,000 individuals, respectively) — fractured or sprained ankles and knees, as well as facial injuries and broken or dislocated fingers
  • Baseball and softball (41.3 injuries per 100,000 individuals) — fractured or sprained ankles and knees, head injuries
  • Football (25.2 injuries per 100,000 individuals) — broken or dislocated fingers, shoulders or knees

These injuries can be costly, even if they don’t result in a trip to the ER. Diagnostic testing, surgeries, physical therapy, follow-up visits, they all add up. According to the U.S. Consumer Product Safety Commission’s National Electronic Injury Surveillance System, the average charges for selected injuries among 25 to 40 year olds are as follows[3]:

  • Leg fracture — $3,403
  • Arm fracture — $7,666
  • Sprains and strains — $3,175
  • Dislocation — $4,757

As we all know, no matter how careful we are, sports injuries aren’t always preventable. Even if you have health insurance, you may wind up paying a substantial portion of related medical bills, depending on your annual deductible and coinsurance amounts.

What to know about emergency care

Under the Affordable Care Act, emergency services are among the 10 essential health insurance that all health insurance plans must include. Though specific emergency services benefits vary based on state benchmark plans, this EHB requires the following for all qualified health plans[4]:

  • Coverage for emergency department services will be provided without a pre-authorization requirement or limit to in-network providers; and
  • When emergency services are received out-of-network, the cost-sharing requirement (i.e., copayment and coinsurance rate) is the same as it would be in-network.

This offers some peace of mind, whether you travel to compete, make sports part of your vacation, or simply become injured in the area where you live and are taken to an out-of-network hospital. However, be aware that you could still wind up paying more for out-of-network care. Read more in our recent post “What You Need to Know About Out-of-Network Emergency Care.”

You should still compare emergency services benefits from plan to plan (e.g., emergency transportation, urgent care, emergency room services), as copay and coinsurance amounts may vary. If you have specific concerns or questions about out-of-network emergency care, contact your health insurance carrier.

Think beyond the ER

But what if your injuries don’t send you to the emergency room? Some benefits you may want to look at closely when comparing plans include:

  • X-rays and diagnostic testing
  • Imaging (e.g., CT Scans, MRIs)
  • Specialists
  • Prescription drugs
  • Inpatient and outpatient physician and surgical services
  • Hospital stays (e.g., inpatient hospital services)
  • Outpatient facility fees
  • Rehabilitative services such as physical therapy
  • Durable medical equipment
  • Chiropractic care and other

Also be aware that under the Affordable Care Act you can no longer be denied major medical health insurance coverage or charged more based on your health history. Furthermore, all ACA-compliant health insurance plans include certain free preventive services.

Save for injuries with an HSA

Whether you shop and purchase coverage on or away from a state or federal health insurance exchange, you may want to consider an HSA-compatible high-deductible health insurance plan and enroll in a health savings account. It can be a great combo if a low-premium, high-deductible plan makes sense for your health and finances.

An HSA allows you to set aside pre-tax wages for later use on qualified medical expenses. The funds roll over year after year—there are no use-it-or-lose-it requirements as with flexible spending accounts. It can be a helpful way to save for unexpected medical care you may need one year and not the next, such as that related to sports injuries.

HSA-compatible high-deductible health plans are typically advertised as such. If you are not sure the plan you want to buy is an HSA-compatible HDHP, call the insurance company to confirm. Many insurance companies that sell HSA-compatible HDHPs also offer HSAs or can connect you with a partner who does. If yours does not, you may obtain an HSA through a financial institution.

Supplement your coverage

In addition to securing health insurance, as required by the ACA, you may want to consider supplemental benefits that help lower out-of-pocket spending when you need medical care.

If you are part of a national club or are licensed in your sport through its governing body, you may have access to low-cost accident medical plans that are designed for active individuals and provide defined benefits upon accidental bodily injury and even emergency evacuation. If not, you may look into such products independently. Free and low-cost prescription drug cards are another supplemental product that can help save you money.

Also remember to buy dental insurance, which is available at websites such as HealthCare.com and also through some state and federal exchanges. Note that Obamacare’s income-based financial assistance (i.e., premium tax credits and cost-sharing sharing subsidies) does not apply to dental plans.

Find the right plan with a little help

Visit HealthCare.com to browse plans in your area. Use HealthCare.com’s subsidy calculator to see if you qualify for financial assistance. If you do, visit your state or federal exchange to shop and enroll in 2015 coverage.

Not sure what plan to choose? To speak with a licensed health insurance agent from one of our trusted insurance partners, call 877-275-0485.

[1] Misra, Arpit. “Common Sports Injuries: Incidence and Average Charges.” Department of Health and Human Services. ASBPE Issue Brief. March 17, 2014. http://www.aspe.hhs.gov/health/reports/2014/SportsInjuries/ib_SportsInjuries.pdf.

[2] Ibid.

[3] Ibid.

[4] 42 U.S. Code § 18022 – Essential health benefits requirements. http://www.law.cornell.edu/uscode/text/42/18022.

[5] Internal Revenue Service. Rev. Proc. 2014-30. Internal Revenue Bulletin. May 12, 2014. Retrieved from http://www.irs.gov/irb/2014-20_IRB/ar01.html.

About Jenifer Dorsey

Jenifer Dorsey is a regular contributor to HealthCare.com. She has covered health insurance and health and fitness for more than five years. In her free time she is a competitive track cyclist and loves to travel, especially to places with velodromes.

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