The Motorcyclist’s Guide To Health Insurance

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The Motorcyclist’s Guide to Health Insurance

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.

The Motorcyclist’s Guide to Health Insurance

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!

The Motorcyclist’s Guide to Health Insurance

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…

  • 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.