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Insurance FAQ

INSURANCE FAQ

ANSWERS TO COMMON QUESTIONS
ABOUT INSURANCE PLANS AND MDLIVE.

For many of us, insurance is confusing. In fact, 27% of Americans say they avoid care or treatment because of confusion about insurance.*

Understanding your benefits and if MDLIVE is included in them is important to know when you seek care.

MDLIVE accepts many types of insurance from major providers like Cigna, Blue Cross, Blue Shield, Humana, and many others. More than 55 million people have MDLIVE as part of their health insurance benefit!

MDLIVE is here to help. Our insurance FAQ is designed to answer common insurance questions and help you be prepared when you need care.

More than 55 million people have MDLIVE
as part of their health insurance benefit.

MDLIVE INSURANCE FAQ

MDLIVE accepts most insurance plans, but it depends on the specific insurance plan you have. To find out if we accept your insurance, you can sign in to your MDLIVE account or register for a free account in about 90 seconds.

Yes, you can have a virtual doctor visit with MDLIVE – even if you don’t have insurance. We will always show you the cost of your visit before it begins. Please note, the price you pay without insurance or if your plan is not in the MDLIVE network will usually be higher than an insurance copay but may be less expensive than Urgent Care Clinic or Emergency Room visits.

If MDLIVE accepts your insurance, the MDLIVE visit fee for you and your eligible dependents will typically be covered according to the details of your benefit plan. We will show you your out-of-pocket visit cost whenever that information is available to minimize surprise costs. Many insurance plans also cover prescriptions and diagnostic tests ordered by a physicianduring a virtual visit. Consult your insurance plan for details.

A copay is a flat fee you pay for specific medical services – usually doctor visits or prescription drugs – often regardless of whether you have hit your deductible. Copays are shown as a dollar amount. For example, “$10 copay per visit” or “$5 copay for generic medications.” For MDLIVE visits, your copay, if any, will be displayed before your visit starts.

Many High Deductible Health Plans (HDHP) use coinsurance instead of copays for doctor visits. Coinsurance is the portion of covered medical expenses you can expect to pay out-of-pocket after you have hit your deductible. Your insurance plan pays the remainder of the bill. Coinsurance is shown as a percentage. For example, if you have reached your deductible and have 20% coinsurance, you would pay $10 out-of-pocket for a visit that costs $50.

An annual deductible is an amount you’re responsible for paying each year for covered medical expenses before your insurance plan begins to pay. For example, if you have a $1,000 deductible and 20% coinsurance, you will generally pay 100% of expenses up to $1,000. After that, you’ll pay 20% until you reach your out-of-pocket maximum. The out-of-pocket maximum is the most you have to pay in one year, out-of-pocket, for your health care before your insurance plan covers 100% of the bill.

If your insurance plan is in the MDLIVE network, we will typically know your obligation concerning copays, coinsurance, and deductibles. We will use that information to inform you of your likely out-of-pocket costs for your MDLIVE visit.

Most doctor visit copays, including MDLIVE visits, typically do not count toward your annual deductible. The most common items that count toward deductibles are surgeries, lab tests, diagnostic tests, and hospitalization.

If your MDLIVE virtual visit is not covered by a copay, it may be eligible to count toward your deductible. Consult your insurance plan for details.

These accounts are ways to pay for qualified healthcare expenses with pre-tax dollars, but they differ in several ways. Individuals can contribute to a HSA if they are enrolled in a qualifying HDPD. The individual owns these accounts, and the money does not expire.

An FSA is an account that individuals can contribute to in order to pay for qualifying expenses with pre-tax dollars; however, there are limits to rolling over the funds from year to year. FSAs should be primarily used for known and anticipated healthcare spending because of the ‘use it or lose it’ feature.

Yes, you can use HSA or FSA funds to pay for the out-of-pocket cost of an MDLIVE visit.

For more information, please sign in to your MDLIVE account or register to check your copay. After that, get the MDLIVE app – available on Apple and Android devices – so you’ll be ready to have a virtual doctor visit anytime, anywhere.

*Source: Policy Genius Study

Tags: insurance, virtual visits, urgent care, copay, telehealth


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Hannah Andrews