The Motorcyclist’s Guide To Health Insurance

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The Motorcyclist’s Guide to Health Insurance

Photo by Ben Roffer

So, Healthcare.gov is up and running, and you’re all excited about picking out health insurance, huh? Well, the site is working, but picking a plan can be brain-splittingly complicated (I nearly split mine doing research for this article), especially if you’re relatively healthy and grumbling about how you’ll never need the stuff anyway. But, if you ride a motorcycle, you can’t ignore the fact that your odds of needing healthcare just went up a little. Here are few things you need to consider:

HMO vs. PPO

HMO vs. PPO

Health Maintenance Organizations (HMOs) focus on wellness. Preventative care and routine visits to your in-network provider are usually well-covered, with less attractive coverage for episodic acute care, diagnostics and the dreaded out-of-network provider. At face value, they often look like the cheapest route, but only when using in network providers: hospitals, labs, imaging centers, emergency medical transport services, pharmacies, therapists…all who have agreed to accept negotiated (lower) rates for whatever service. Stray outside the network, and coverage can be minuscule. HMOs tend to be more restrictive when it comes to seeing specialists or obtaining expensive diagnostic exams or treatments, and might not approve your provider’s recommendation until it can be reviewed by their own auditor (who may or may not be a physician, by the way). Get used to things like needing “prior authorization” before procedures and/or diagnostics, and needing a trip to your primary care provider before getting a pass to see a specialist.

Preferred Provider Organizations (PPOs) also favor in-network providers, but may have slightly higher monthly premiums and co-pays in lieu of less restrictive management. They tend to have a larger pool of participating providers (because reimbursement rates are better) and less disparity between in and out of network coverage.

Implications For Riders: Injuries from a motorcycle accident typically cost more money to diagnose and treat than a typical trip to the doctor’s office. They’re also less amenable to choice when it comes to where you get the care you need. Consider what you’re most likely to need health insurance for: management of a chronic problem vs. treatment for an acute illness or injury? Also consider what kind of riding you do: touring (out of network or out of state?) vs. commuting (where in-network coverage is readily available)? Consider if any of this even matters to you, or your family, or whoever ends up getting stuck with the bills if you have a serious collision.

The Motorcyclist’s Guide to Health Insurance

Photo by Eric Schmuttenmaer

What About The Deductible?

This is the amount you have to spend (per calendar year) on eligible expenses before your insurance kicks in. This does not include what you spend on monthly premiums and co-pays. You’d like to think it’s that simple, wouldn’t you? It’s not. Each plan describes what can and can’t be applied to your deductible, and each defines “eligible expenses” differently. You literally have to read each and every plan’s definition. Yes, really.

Implications For Riders: One trip to the ER for a motorcycle accident is likely to take care of you entire deductible. Ouch. And, yay!

Continue Reading: The Motorcyclist’s Guide to Health Insurance >>

  • http://thecrumb.com/ thecrumb

    I’d like to hear if people use MASA (Medical Air Services Association). I know AMA offers a discount. When I got hit by the deer a few years ago on the BRP I was airlifted out. I probably didn’t *need* to be but can’t fault the EMT’s for erroring on the side of caution.

    http://masaamerica.com/masaamerica/Welcome.html

    I thought I was going to have to call the EMT’s when my wife opened that bill. :)

    • BillW

      I’ve got similar coverage from MedJet Assist (discount through BMW MOA), but I’m happy to say I’ve never had to use it, so I can’t comment on its effectiveness. But I’m a sport-touring rider, and I’d like to be able to get myself shipped back home if something bad happens.

    • Jason

      AirMed airlifted my wife and I out of Bulgaria after a motorcycle accident. Top notch company, I can’t recommend them enough. Website: http://www.airmed.com

  • ChrisB

    This is not a problem or even a consideration for any other first world industrialized nation in the world except… US. You get hurt in an accident? You just go to the hospital without worrying about what the 6 figure bill could be once you get out. Or if your insurance covers it. Or if you’re care will get denied coverage. There’s a story of a man refusing a ride in an ambulance after a motorcycle crash because he knew he wouldn’t be able to afford the hospital care. Lord help you if the ambulance company that takes you to the ER is not in network.

    • NOCHnoch

      Scandinavia, here I come!

    • BillW

      Sad, but true. Somehow, we’ve let capitalism become our political and religious system instead of just our economic system.

      • taba

        Not even wrong.

    • Mark D

      Yes, but think about all freedoms we have, like the freedom to work full-time jobs for below a living wage, be arrested and thrown in jail for the rest of your life for growing and igniting a common plant, or having the Federal Government print money to bail you out of your own mistakes (some restrictions may apply).

      • ChrisB

        Kinda makes all of the statements on HFL and RideApart about people in the US being big babeiz being risk adverse ring hollow… You’re one big medical mishap away from being fuct for life here.

      • jgroszko

        We’re not *that* free! The Fed only prints money for you if you fuck up on a scale that affects the entire economy!

  • TP

    Thank you! You guys listen :)

  • Piglet2010

    Most people that go bankrupt from medical costs started out with insurance. In general, your house and one vehicle is all you can protect when declaring Chapter 7 bankruptcy.

  • jgroszko

    A lot of times looking at insurance I’ve seen exemptions for participating in racing or speed competitions, how does this apply to track days? Do people usually have to argue with their insurance over track day accidents? Do people have to get special coverage to participate in track days?

  • Justin McClintock

    Anybody looked to see if the new healthcare laws affect insurance on motorcyclists in any way? I know some policies have some loopholes for things like motorcycles and skydiving. Wondering if the new healthcare laws closed those.

    • Adam

      There is a chance what you are thinking about is life insurance not health insurance. Life insurance is priced based on risk so they ask a lot of questions about your hobbies…recent (a few years) sky diving and bungee jumping might cause you to get a higher premium, as well as a history of various diseases in your family. Historically when applying for individual/open market coverage health insurance companies were allowed to discriminate and/or charge more when the person already had pre-existing conditions that might cause you to use more health care (diabetes, high blood pressure, obesity, being female) . This practice was ended with Obamacare and now the only mitigating factors are location (zip code), age and I think if you are a smoker. I dont think any hobbies changed health insurance rates.

      Also I would speculate that sky diving accidents result in fairly minimal costs to the health insurance company because most likely you will be declared dead at the scene.

    • Heather McCoy

      The new healthcare law (I assume you’re referring to the Affordable Care Act, a.k.a. Obamacare) does not close the loopholes (the correct term is “exclusionary riders”) for “high-risk” behavior, like motorcycles, skydiving, or anything else any insurer wants to define as “high risk”. The ACA no longer allows insurance companies to discriminate when it comes to OFFERING you insurance (i.e., you can’t be turned down), but there’s no law saying what they have to/don’t have to cover. Case in point: the whole issue of employers withholding coverage for contraceptive care on the basis of religious freedom. Better hope your employer doesn’t have some weird religion that thinks motorcycles are evil. Or one who doesn’t believe in blood transfusions if you get hurt on one.

      Once upon a time, there was some momentum to fix this on a national level. The HIPAA Recreational Injury Technical Correction Act reintroduced by Sen. Susan Collins of Maine in 2007 died after being referred to committee. I believe individual states are trying to handle the problem, no doubt with all the urgency of waking up from a nice, long nap on a Sunday afternoon.

  • Joe Bielski

    Dear fr@king god… That’s horrible :(

  • Von

    what about life insurance if we get hurt bad enough to not work again? any advice on that?

    • wbizzle

      Look into some form of long term disability insurance.

  • notfishing

    Insurance is good but take some responsibility.

    My first broken collarbone (jumping horses not on a motorcycle and wearing a helmet). Ambulance, EMT’s the works – but I needed it and I was thankful I knew how to fall.

    Second broken collarbone (on a bicycle also wearing a helmet), even though I tried to protect my custom bike the wheels and my helmet were trash. I got up, pushed / carried the bike back the two miles to my van and drove myself to the emergency.

    You do have a few options on controlling costs after you’re hurt.