Category Archive

2023 January

Copays, Coinsurance, and Deductibles

2023 January, Benefit Spotlight December 27, 2022

If you’re new to having your own medical insurance plan (or maybe even if you’ve had one for a while), the terminology surrounding how much you have to pay for a given service can be confusing. Let’s look at some of the most important terms that will help you better understand your benefits:

Deductible: A deductible is a fixed amount of money that you have to pay before your insurance starts paying benefits. For example, if your deductible is $2,000, you’ll pay out-of-pocket until you reach that amount, and then your coinsurance will kick in. This amount varies by plan, but typically plans with higher monthly costs have lower deductibles and plans with lower monthly costs have higher deductibles. (Side note: some plans have separate deductibles for prescription benefits, so make sure to check your plan details for this.)

Coinsurance: Coinsurance kicks in once you’ve reached your deductible. Now whenever you have a covered medical expense, you’ll pay coinsurance, which is a set percentage of the total cost, and your insurance will pay the rest.

Copay: This is a set amount you’ll pay for a covered service and varies per service. You may pay copays before you hit your deductible and after; this varies by plan.

Out-of-pocket maximum: This one is a little more self-explanatory. Once you’ve paid this set amount out-of-pocket, your plan will pay 100% for covered services for the rest of the year. Depending on your plan, your deductible may or may not include to your out-of-pocket maximum.

Each plan has different deductibles, coinsurance, copays, and out-of-pocket maximums. It’s important to review your benefits carefully to make sure you know what you’re on the hook for when you receive medical care. Consult your summary plan description for more information.

How do deductibles, coinsurance and copays work? |
Your total costs for health care: Premium, deductible, and out-of-pocket costs |

In It Together – Couples Counseling

Many people find they needed extra support in maintaining good mental health — whether that be via in-person counseling or online therapy sessions. It may not be discussed as often, but sometimes couples need a little extra help, too.

There are plenty of reasons couples may want to talk to an experienced, neutral counselor. They may have experienced conflict around significant life events like a big move or welcoming a new child to the family. Other common communication issues center on finances, parenting, or personal priorities. Couples therapy isn’t about blaming anyone – it presents opportunities to learn better communication skills, help resolve feelings of resentment or distance, and assist in finding compromise. It can help partners learn more about themselves and one another, which leads to healthier relationships on the whole.

(An important side note: Couples counseling is not recommended for couples containing an abusive partner. Bringing up the issue to a third party can often create more conflict and abuse. In this situation, individual counseling for the non-abusive partner may be a good starting point. If you are in this kind of relationship and are seeking help, please click HERE for resources.)

The great news is that many counseling providers began or expanded virtual options during 2020 and seem unlikely to move back to primarily in-person models. There are many providers to choose from (see HERE). Not all of these providers accept insurance, and some are pricier than others, so be sure to double-check before making your first appointment.

Safety Net: Healthy Online Habits for Kids

Many of us were introduced to the internet as young adults or even later in life, but it’s important to consider another group that has easy access to the internet – young children and teens.

According to 2018 Pew Research data, 95% of teenagers report having access to a smartphone, and 45% say they are online almost constantly. Younger children are also online more than they used to be. An April 2021 Pew Research study saw rising percentages of children between 5-11 using digital devices and social media sites.

While the internet can be a fantastic resource, it can also be a dangerous place for kids who don’t know better. The internet holds inappropriate content and malware, perpetuates scams and cyberbullying, and can hide sexual predators. To keep kids safe, it’s important to teach them some basic internet boundaries:

  • Keep personal information private.
  • Don’t talk to strangers or meet up with someone you’ve only met online.
  • Tell a trusted adult about inappropriate or bullying messages.
  • Don’t open emails or click links from someone you don’t know.

There are a host of websites, resources, and apps you can use to help keep your kids safe online. It’s important during this process to establish open, trusting communication with your kids. This will help them understand you’re trying to help them learn to navigate potentially treacherous waters and to feel comfortable sharing any suspicious online behavior with you.

Nutritional Boosts

Most of us would like to eat more healthily but may not know where to start. The good news is that there are some easy dietary shifts you can utilize:

Sodas. Full-sugar sodas contain a lot of empty calories and a LOT of sugar (up to Mountain Dew’s 77 grams per 20-ounce bottle). In contrast, the American Heart Association recommends that adults limit their daily consumption to 25 to 36 grams. If you crave a sweet bubbly, try swapping out your regular soda for a reduced-sugar or sugar-free version. While they’re more expensive, there are also several kinds of low-sugar probiotic sodas or even kombucha that are delicious and good for your gut. Flavored sparkling water also gives the carbonation hit without a high dose of sugar.

Snacks. When you get hungry in the middle of the afternoon, it’s easy to reach for a bag of chips or a candy bar, but these snacks won’t do much to fuel your body. Beef jerky, low-sugar trail mix, almonds, and various fruits and vegetables will provide you with nutrients like protein, healthy fats, and fiber to nourish your body and leave you satiated for longer. (See HERE for more suggestions.)

Punch up meals. Making your diet healthier doesn’t mean you have to give up food you like. Try looking for recipes that add fruits and vegetables or lean proteins to classics, like THIS grilled cheese recipe or THIS tomato soup that doesn’t rely on heavy cream for texture. If you’re looking for easy vegetable additions to a meal, whether for yourself or any picky eaters at home, try air-frying Brussels sprouts or making your own oven-baked sweet potato fries.

While these may seem like small changes, when implemented daily, they will stack up quickly. All it takes is a few adjustments to your grocery list and a little dedication.