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
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.
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 >>