Introduction

Despite having health insurance, many Americans are forced to resort to crowdfunding to cover their medical expenses. In this article, we explore the reasons behind this concerning trend and provide insights into how individuals can avoid facing similar financial burdens.

Out-of-Pocket Maximums and In-Network vs. Out-of-Network Providers

Health insurance policies typically have out-of-pocket (OOP) maximums. Once an individual reaches their OOP max, the insurance company covers 100% of in-network medical costs. However, if an individual receives treatment from out-of-network providers, they are responsible for the difference between the OOP max and the total cost of care. This can result in significant financial liability.

Underinsurance and Lack of Coverage

Underinsurance occurs when an insurance plan provides insufficient coverage for an individual’s medical needs. This can happen if the plan has high deductibles or coinsurance rates. Additionally, certain treatments or medications may not be covered at all by some insurance plans.

Additional Expenses Associated with Illness

Cancer treatments and other serious illnesses can incur expenses beyond direct medical costs. These include:

Lost wages
Childcare costs
Travel expenses
Non-medical expenses (e.g., lawn care, cleaning)

These additional expenses can add up quickly and strain an individual’s financial resources.

Gaps in Coverage

Even with adequate insurance coverage, individuals may still face unexpected expenses due to gaps in coverage. For example, many plans have annual limits on certain services. If an individual exceeds these limits, they may be responsible for the remaining costs.

Unforeseen Circumstances

Medical emergencies can occur at any time, regardless of health insurance status. These events can result in significant medical bills that can be difficult to manage without financial assistance.

How to Avoid Crowdfunding for Medical Costs

While it is not possible to eliminate all medical expenses, there are steps individuals can take to reduce their financial burden:

Choose a comprehensive insurance plan: Look for plans with lower deductibles, coinsurance rates, and coverage for necessary treatments and medications.
Consider supplemental insurance: Supplemental insurance policies provide additional coverage for out-of-pocket expenses, non-covered services, and other gaps in coverage.
Shop around for providers: Compare costs and services offered by different healthcare providers. In-network providers typically have lower costs than out-of-network providers.
Negotiate medical bills: Contact healthcare providers and insurance companies to negotiate lower costs or payment plans.
Seek financial assistance: There are many government and non-profit programs that offer financial assistance to individuals with medical expenses.

By understanding the reasons behind the high cost of medical care and taking proactive steps to manage expenses, individuals can avoid or minimize the need for crowdfunding to cover their medical bills. If you need help finding an insurance plan or accessing financial assistance, please contact a licensed medical insurance agent.