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Understanding Your Health Insurance Deductible

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The start of the new year can be a confusing time when it comes to health insurance coverage and medical costs, particularly if you or dependents have diabetes. Perhaps you made some changes during open enrollment, or your options for healthcare providers and/or coverage were different. The beginning of the year is also when health insurance deductibles reset. You may be wondering the most effective way to plan for upcoming medical expenses throughout the year based on your coverage. We’ve compiled answers to some common questions related to health insurance deductibles to help you plan ahead. We recommend you always speak to your health insurance provider with specific questions before making any decisions because coverage plans vary greatly by region and provider and each will have different requirements.

Whether you’ve met your deductible or not, Medtronic has many programs, such as our Flex or Next Tech program, that can help make our therapies more accessible. We encourage you to reach out to our team for assistance with your insurance needs at 855-539-3681.

What is a health insurance deductible?

For those of you that have health insurance, a deductible is the amount of money you pay out of pocket for health care services before your health insurance company will begin to pay for services, including medical devices.

What does it mean when annual deductibles reset?

When deductibles reset, you’ll owe the full cost for health care services up to the amount of your annual deductible.  Once you’ve reached your deductible, your insurance plan starts paying its share of the cost and you pay your share. This is why healthcare items that you purchase at the beginning of the year may initially require more out of pocket cost. To help with this, Medtronic provides flexible options and payment plans to those who qualify.

How do I know what my deductible is?

Check with your coverage plan to verify the deductible specific to your plan, which is typically different for individual vs family coverage. For assistance, you may also call our team at 855-539-3681 for benefits verification.

What can I do about my health insurance deductible resetting?

Thoughtful planning throughout the year can help control health-related expenses.  Why?  Because if you need to pay for medical expenses regularly, knowing how close you are to meeting your deductible can help you control out of pocket cost.  If you have met – or are close to meeting – your deductible, your out of pocket costs are likely to be lowered for covered medical treatments and services.

If I have a flexible spending account or health savings account, can this help pay towards my total deductible amount?

A flexible spending account is an arrangement through your employer that lets you pay for many out-of-pocket medical expenses with tax-free dollars. Allowed expenses typically include insurance copayments and deductibles, qualified prescription drugs, insulin, and medical devices, but you should verify this with your insurance provider.

Do doctors’ visits and prescriptions help meet my deductible?

This varies by health insurance plan, but typically a copay to a doctor’s office or a visit to the pharmacy does not go toward your deductible or out of pocket maximum. It’s best to call your insurance company to verify.

What is an out of pocket maximum?

Many health insurance companies have an out of pocket maximum which means that you have a set amount either individual or for your family, and once your costs reach that amount, you’ll no longer have copayments for major medical expenses.  It’s best to call your insurance provider to verify.

When is the best time of year to meet my deductible?

Timing varies on a case-by-case basis and can be a personal decision.  If you only require preventive care or your insurance plan charge a fixed copay for doctor visits, you may not be concerned with meeting the deductible.  However, if you have a number of significant covered medical expenses, it might be helpful to meet your deductible earlier in the year so that future medical treatments or services throughout the year will only require your copayment. Having met your deductible can also help with unexpected expensive medical expenses such as ER visit or surgery.

That’s why thoughtful planning is important.  Some people delay the more expensive medical expenses until the end of the year (if they can) when they are more likely to reach their deductible.  On the other hand, others may want to reach their deductible earlier in the year if they know they have to pay for other medical expense throughout the year anyway, or if they don’t want to be caught off-guard by emergency medical costs.

What happens when my medical deductible is met?

Depending on your healthcare plan, once your deductible is met you will pay a copay or small percentage for additional medical expenses for the rest of the year until it resets again. Contact your insurance provider or call our team at 855-539-3681 for more information.

Is there anything that Medtronic does to help with the cost of their products?  

Medtronic strives to help make diabetes management more accessible.  We provide a number of programs as well as flexible financing options to help eligible customers start on therapy.

Our Flex program allows eligible customers to start pump therapy for around $49*/month.  For more info, visit www.medtronicdiabetes.com/flex

Our Next Tech Pathway program allows eligible customers to buy today and upgrade to the next technology we release for $0.  Never fear of missing out.  Order must be placed by 4/1/20 to qualify for this special offer.  For more info, visit www.medtronicdiabetes.com/nexttech

Do you have an old insulin pump to trade in?  Our Pump Trade-in program allows eligible customers to receive up to $500 trade-in credit** after purchase of an insulin pump and return of an old insulin pump.

We also offer payment plans or financial assistance to new or existing customers who are eligible.  Please call for eligibility.

Reach out to our team at 855-539-3681 between 8am and 6pm CST for benefits verification and discover the plan that works for you.

Eligibility requirements apply. Some programs may not be combined.

*$49/month estimate is calculated based on average out-of-pocket cost paid over 48 months. Monthly payments include a $6/month service fee.  Final cost may be higher or lower than $49/month depending on individual insurance.

**$500 credit for Medtronic pump, Tandem® pump, Animas® pump, or Roche® pump. $250 credit for Omnipod® receiver. Terms and conditions apply.

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