Out of Pocket, in the Picture: Your Healthcare Deductible and Imaging, Explained
Health insurance helps individuals or families pay for medical care, but it doesn’t cover all your healthcare expenses. Typically, you’ll have to pay out of pocket for some services, including diagnostic imaging scans, until you reach your healthcare deductible.
As a result, if you need a CT scan, an MRI scan, or another type of diagnostic imaging, maximizing affordability is key. Standalone imaging facilities, such as American Health Imaging centers, offer both cost savings and convenience.
Understanding ‘healthcare deductible’ and other related terms
Your out-of-pocket cost for your imaging scan will count toward your deductible, which is the amount you must pay before your insurance picks up part of your bill. Once you meet your deductible, your insurance will pay a large percentage of the cost of covered services, and you’ll pay a smaller percentage, or coinsurance. Annual healthcare deductible amounts vary by insurance plan and can range from no deductible at all to thousands of dollars.
Paying out-of-pocket costs, such as your deductible, coinsurance, and copays—predetermined amounts for covered services—is known as cost sharing. When you reach your out-of-pocket maximum, or the maximum amount that you’re permitted to pay out of pocket during the coverage period, your insurance will pay 100% of the cost of covered services. Certain expenses, such as your monthly premiums, non-covered services, and out-of-network services, don’t count toward your out-of-pocket maximum.
Fully covered, no-cost scans
Not all imaging scans come with out-of-pocket costs. Certain preventive health screening scans may be available at no charge, depending on your insurance plan. These scans include:
- Low-dose CT scan for lung cancer. Coverage for this screening is available for certain older adults who currently smoke or smoked heavily in the past. A low-dose CT scan can help detect lung cancer early, increasing the chances of successful treatment.
- Screening mammogram for breast cancer. A type of X-ray scan, a screening mammogram can find potentially cancerous breast abnormalities before you can see or feel them. Under the Affordable Care Act, women’s preventive healthcare services, including annual screening mammograms and cervical cancer screenings, are covered in full.
Check with your insurance provider to find out whether your plan covers certain screening scans at no cost.
Preferred providers: saving you money on the road to meeting your healthcare deductible
No matter your healthcare deductible amount, you want to seek out affordable services without sacrificing quality. Some plans, such as preferred provider organization plans, work with medical providers to set discounted rates for services. Some of these preferred providers may be non-hospital-owned, outpatient imaging centers.
Your insurance plan may categorize contracted providers by tiers. Within this tiered coverage, preferred providers offer the largest discounts on covered services. Participating providers offer smaller discounts. When deciding where to undergo an imaging scan, you can make the most cost-effective decision by consulting your insurance plan to find a preferred provider.
American Health Imaging is in network with 99% of health plans. In addition, our scans cost 40–60% less than those at hospitals, so you’ll pay smaller out-of-pocket fees. This is key if your insurance doesn’t cover a particular imaging service or denies a scan. Your insurance may deny an MRI or CT scan, for example, if the carrier believes that a less costly form of imaging, such as an X-ray, would be sufficient. Our compassionate staff will work with your insurance on obtaining preauthorization for a scan, if necessary.
Wondering how much an MRI or CT would cost? Our cost calculator can provide an estimate. You also won’t have to worry about receiving multiple bills from American Health Imaging. We’ll give you one, consolidated statement.
FSAs, HSAs, and your healthcare deductible
If your insurance plan includes a flexible spending account (FSA) or a health savings account (HSA)—accounts to which you contribute pre-tax money to use on healthcare expenses—you can use it to pay for imaging scans and other costs that count toward your healthcare deductible.
Typically, you have to spend FSA money during the plan year, which may coincide with the calendar year, or you’ll lose it. However, your employer may offer a two-and-a-half-month grace period or allow you to carry over up to $610 to the next plan year. If you are near the end of the plan year with unspent FSA funds—and you have a doctor’s order for an imaging scan to help your physician make a diagnosis—schedule an imaging appointment. Getting a scan could lead to a diagnosis—and a better quality of life—is far better than letting that FSA money go to waste.
High-deductible health plans often feature HSAs. Unlike FSA money, HSA funds roll over from plan year to plan year. You can use your HSA to pay for out-of-pocket imaging costs anytime without fear of losing the money.
Getting the most out of your insurance throughout the year
How you use your insurance—and your strategy for seeking imaging services—may change throughout the year. Early on, finding the best rates on imaging scans, especially for non-urgent services, may be especially important because you’ll be paying your healthcare deductible.
Later in the year, once you meet your deductible, you may be wondering how to get the most out of your insurance benefits. One way is to undergo medical scans your doctor ordered to investigate long-term issues, such as knee or neck pain, that are hampering your quality of life. These scans may include:
- Arthrogram—a scan of the joints, typically using X-rays and contrast dye, that can show torn ligaments, cartilage problems, and other causes of pain
- Myelogram—an X-ray or CT scan of the spine that can show a variety of injuries, including herniated discs and spinal stenosis
- Ultrasound—a sound wave scan that can help doctors diagnose arthritis, among other conditions
No matter when you visit an AHI center, you’ll receive compassionate care using the latest imaging technology—and you’ll save money.
Have a doctor’s order for an imaging scan? Choose convenience, cost savings, and precision by trusting your care to American Health Imaging. Contact a center near you to schedule an appointment.