Out-of-Pocket Maximums: This is a nice number; the lower the better. Like some glistening beacon twinkling with promise at the end of the dark, scary, fire swamp of insurance plan comparison hell, this amount is the most you’ll pay per year for health-related expenditures. It includes what you fork over in co-pays, out-of-pocket expenses, and that big deductible. It does not include your monthly deductible. Nothing does.
Implications For Riders: All those things that aren’t covered by your plan (like that hand-carved knotted-pine cane or having Helga, your private duty physical therapist come to your office to work the bejesus out of your rotator cuff twice a week) get lumped into this pile. Sadly, the lower your out-of-pocket maximum, the higher your monthly premium. Darn.
Photo by Kristine Laprise
Co-Payments and Co-Insurance: This is what you’ll pay every time you show up somewhere needing something from someone wearing rubber gloves. Rates are all over the map, from zero to what-the-heck-am-I-paying-you-for-every-month?
Implications For Riders: Here is where you find out how much the ER is going to cost you before you even set foot in the door. Pay close attention to this number.
As for a trip to the ER, if you need it, you need it, but coverage varies widely by plan. Co-pays are typically a couple hundred dollars, but can be way more if your plan is a stickler for in-network facilities. If you’re in any shape to request, and/or it’s medically safe to do so, EMS will usually transport you to the facility of your choice (within reason of course; they’re not taking you to Johns Hopkins in Baltimore when you crash in Philly). The transport service by the way, is an entirely separate cost.
For injuries that do require immediate evaluation, you’re most likely going to get sophisticated diagnostics (CTs, MRIs, etc.) and a handful of physicians in different specialties meddling with you. Consider this scenario: you have a nasty high side on an otherwise perfect track day. You’re bell was rung, and you wake up dazed and confused in the ambulance. You’re in a collar, and your hip hurts like a son-of-a-gun, especially when you try and move your leg. Good news! You’ve got a concussion, a C7 spinous process fracture, and the pelvic hematoma that ate Manhattan! You’re going home with some Percocet and a bag of ice, but not before you’re seen by the ER doc, a trauma surgeon, a radiologist (who doesn’t actually see you, but reads your imaging studies), a neurosurgeon, an orthopedic surgeon, and a hospitalist. Congratulations on meeting your annual deductible in one fell swoop!
Photo by Jan Ivar Sørensen
What About Exclusions? It’s common for plans to exclude coverage for things like elective cosmetic surgery and dental work, but there’s usually more buried in the proverbial fine print. These are things that too often aren’t realized until you get that bill in the mail that triggers immediate chest pain and palpitations (relax, everyone covers that). Insurance companies can be equal opportunity discriminators. Just like some plans won’t cover family planning (based on your employer’s religion) or abortion services in the case of rape (Michigan), some plans might not cover healthcare costs incurred from riding your motorcycle. Or being on the back of someone else’s. Or if you weren’t wearing protective gear when it happened. Or if you were skiing or bungee jumping or T-boned by a UFO. Coverage for things like physical therapy, home health care, certain drugs, and all kinds of unexpected health-related things may be minimal or non-existent. The only way to know this is to read your policy. All of it.
Implications For Riders: Motorcycle injuries are expensive, and the worst of them can render you worse than dead. Medical costs for the first year of a severe traumatic brain injury average over a million dollars, with annual costs thereafter of about $100,000 per year. Did I mention almost all plans have lifetime maximums? Mitigate your risk by picking a health plan that provides the best coverage for what you’re most likely to need, never riding without proper motorcycle insurance, signing up for a MSF Riding course, and by wearing all the gear, all the time.
Now…about that smoking habit of yours…