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From Confusion to Clarity: Understanding Health Insurance

Published by Mike Beltowsky

At Gateway Recovery Center, we understand that navigating the world of health insurance can be overwhelming. Especially when the need for medical detox arises and immediate care is required. Our 24/7 Admissions Team consists of insurance experts who are available to assist with understanding insurance coverage, ensuring access to care is quick, easy, and stress-free. We understand that each individual’s insurance plan is unique. Our team verifies benefits to provide a clear understanding of what is covered under each policy.


With so many different terms and concepts to understand, it’s easy to feel overwhelmed and unsure of what you’re actually paying for. In this blog post, we’ll break down some of the most important terms to know when it comes to understanding your health insurance coverage.


Monthly Premiums:

One of the most basic concepts of health insurance is the monthly premium. This is the amount of money you pay each month to maintain your health insurance coverage. The premium amount can vary depending on your plan, your age, your health status, and other factors.



A deductible is the amount of money you are responsible for paying before your insurance coverage kicks in. For example, if you have a $1,000 deductible and you need to have a procedure that costs $2,000, you will be responsible for paying the first $1,000 out of your own pocket. Once you have met your deductible, your insurance will begin to cover the remaining costs of your care.



A co-pay is a fixed amount that you pay out of pocket for a specific medical service or prescription drug. For example, you might have a $20 co-pay for a doctor’s visit or a $10 co-pay for a prescription medication. Co-pays can vary depending on your plan and the type of service or medication you need.



Co-insurance is the percentage of the cost of a medical service that you are responsible for paying after you have met your deductible. For example, if you have a 20% co-insurance rate and a medical service costs $1,000, you would be responsible for paying $200 out of pocket, while your insurance would cover the remaining $800.


Total Out-of-Pocket Costs:

Your total out-of-pocket costs are the maximum amount of money you will be responsible for paying for your healthcare in a given year. This includes your deductible, co-pays, and co-insurance. Once you have reached your out-of-pocket maximum, your insurance will cover 100% of your medical expenses for the remainder of the year.


Single Case Agreements (SCAs):

A SCA is an agreement between an insurance provider and a healthcare provider for services that are not covered under the insurance plan. SCAs may be necessary for individuals who require specialized medical care that is not typically covered by their insurance plan. For example, if you need to see a healthcare provider who is out-of-network or if you require a treatment that is not covered by your insurance plan, Gateway Recovery Center may be able to negotiate a single case agreement with your insurance provider to cover the costs.


Direct Access:

Minnesota’s Direct Access allows uninsured and underinsured individuals who meet Medicaid Income Eligibility Guidelines with substance abuse issues to directly access necessary treatment services without requiring a referral or prior authorization. This initiative aims to remove barriers to treatment and streamline the process for individuals seeking help for substance abuse. Individuals admitting to Gateway Recovery Center under direct access complete a Rule 24 application to receive funding for medical detox and ongoing SUD treatment.


Minnesota Medicaid (Medical Assistance):

MN Medicaid, also known as Medical Assistance, is a state and federal program in Minnesota that provides healthcare coverage to individuals and families with limited financial resources. Administered by the Minnesota Department of Human Services (DHS), MN Medicaid ensures that eligible individuals have access to a wide range of medical services, including doctor visits, hospital care, prescription medications, and mental health services. It plays a crucial role in supporting vulnerable populations such as low-income individuals, children, pregnant women, seniors, and individuals with disabilities.


To qualify for MN Medicaid, individuals must meet specific income and eligibility criteria determined by the state. Eligibility categories include families with children, pregnant women, adults without dependent children, and individuals with disabilities. Once approved, recipients receive a Medical Assistance card, which can be used to access covered services from healthcare providers who accept Medicaid.


Individuals can find information on Minnesota’s Medicaid Income Eligibility requirements here.


Talk to an Expert at Gateway Recovery Center

It’s important to note that every health insurance plan is different, and the terms and coverage amounts can vary widely. The experts at Gateway Recovery Center are available 24 hours a day, 7 days a week at 1.833.DETOX.80 (833-338-6980) to help you understand the specifics of your plan and verify your benefits for medical care and detox services. By having a clear understanding of your health insurance coverage, you can make informed decisions about your healthcare and avoid any surprises when it comes time to pay for your medical expenses.


Experience leading treatment with one call. Call us at 1.833.DETOX.80 or submit a verification of benefits to speak to a LIVE Admissions Representative 24 hours a day, 7 days a week..

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