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Out of Pocket Healthcare: What You Need to Know

By Brandi Goodman

Out of Pocket Healthcare: What You Need to Know

Trying to determine your healthcare and insurance can sometimes seem as confusing as a Rubik’s Cube. Many people fail to realize that even with a health insurance plan in place, they will still have additional costs to cover. Yet the insurance company does not handle all related expenses.

Instead, you the patient will have out-of-pocket costs for anything out of network, as well as those services your agency does not cover. There is a lot to consider before you select the right health plan for you.

Why An Out of Pocket Healthcare Program Makes Sense

An out of pocket healthcare program makes people stop and think about what they’re spending. Rather than rely on insurance to pay for all medical care, consumers must handle some of the costs themselves. A program like this makes sense because of the pocket maximums that get set, and the reimbursement option that follows. Once a person spends so much per year on copays, deductibles, and services, their pocket limit will be met and the insurance agency will pick up the rest of the tab. This means you won’t be paying out of pocket forever, which is a significant advantage over having no insurance at all.

Who Needs an Out of Pocket Healthcare Program?

Everyone should enroll in an out of pocket healthcare program. It encourages the use of preventative methods and healthy habits for maintaining well-being. Millennials are already doing this, yet relying on a DIY approach entirely in some cases. While this may be fine while you’re healthy, it won’t suffice when you need true medical intervention.

Most employees who enroll in a healthcare plan with their employer are already set up for an out of pocket system. Those who are self-employed or running a small business should also look into the available options through the health insurance marketplace.

What Would an Out of Pocket Healthcare Program Look Like?

An out of pocket program may look a little different for everyone, but there are enough similarities to help you understand what to expect. The setup of your health plan will most likely include the following.

A Monthly Premium

This is the amount you pay for health care coverage each month. If it’s set up through your employer, this amount may come out of your check automatically. People either pay annually, quarterly, or monthly, depending on what you can afford and how you choose to set it up. Some employers may also have an automatic designation, meaning you’ll have to abide by their schedule.

A Deductible

This is the amount you must spend for medical costs before your insurance will cover anything. This does not include any free covered services offered by your agency. Advantages and disadvantages exist for both a high deductible option and a low deductible choice.

A high deductible means you’ll have to spend more before your insurance kicks in, but you often have a lower monthly premium to make up for it. Plus, you’ll often receive a tax-free spending account if your plan qualifies. A low deductible means you won’t have to spend as much before your insurance begins covering services. However, monthly premiums will be higher to account for this. The higher deductible is worthwhile for those who only need preventative services, while a lower deductible is better suited for those who need medical care more often, such as if you have chronic illness.


This includes the amount you will pay upfront at each visit. It typically includes a set dollar amount for particular visits and a percentage amount for hospital services. For example, your insurance may require that you pay $30 for every office visit, yet 20 percent of total costs for an emergency room visit. The specific amount will be indicated at the time you set up insurance so you know what costs to expect.

Non-Covered Services

There are some services your insurance agency will not cover at all. These will be entirely paid by you. Non-prescription medications and cosmetic surgery are usually included in this category.

How Much Would an Out of Pocket Healthcare Program Cost?

Each person’s healthcare program will cost a different amount, depending on their insurance company, employer, and selected terms. However, the average American employee spent more than $1,700 prior to reaching their deductible. It’s estimated that roughly five percent of your annual income accounts for out of pocket healthcare costs.

What Innovations Are There in Personalized Healthcare?

Some people are cutting out insurance altogether and instead turning to personalized healthcare solutions. For example, Amazon now offers One Medical, a program dedicated to offering virtual and in-office visits to boost overall health and well-being. With a basic membership fee of $199 per year, you gain 24/7 access to the correlating app and receive virtual visits to assist you with your current medical dilemma. They will even help you find and schedule an in-office visit should you need it. Although, these visits will require an additional cost. The goal of this program is to reestablish a true doctor/patient relationship and cut out the red tape of the insurance business.

What Is the Advantage of Chiropractic Being Part of a Personal Healthcare Program?

Medical visits are often only necessary once serious issues arise. For prevention, chiropractic care is one of the best services you can utilize. When you’re looking to relieve pain, increase range of motion, manage symptoms related to chronic pain and illness, and alleviate stress, chiropractic treatment is a worthwhile solution. You may experience a minor side effect, such as soreness or muscle stiffness, but this should subside quickly if you’re drinking water and following the chiropractor’s advice. Overall, chiropractic is a suitable option for anyone experiencing neck pain, back pain, limited mobility, or increased tension anywhere in the body.

Begin Your Healthcare Routine With The Joint Chiropractic

Having an out of pocket healthcare plan is a rewarding solution overall when you’re looking to manage your health. Though you may have to manage some upfront costs, your insurance company will cover a significant portion, ensuring you can receive the services you require to maintain your well-being. Pair this with chiropractic adjustments from The Joint Chiropractic to experience reduced pain and symptoms and aim for prevention. It may help you reduce the costs of medical care tremendously and be one of the most important pieces of the healthcare puzzle that keeps you on your journey toward improved wellness.

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