Get to know your health insurance policy so you better understand its benefits (and shortcomings)
The open road, endless trails, and challenging climbs — cycling is one of the world’s favorite hobbies. But it’s also one of the more dangerous ones. Every time you hop on a bike, you’re at a higher risk of injury compared to your knitting counterparts. And your health insurance company probably knows this and charges you accordingly.
Regardless, you may think you’re fully covered for certain injuries under your current policy … but what if you aren’t? This guide pulls together some important info on how to better understand your health insurance policy.
Health insurance loopholes
The healthcare industry has its issues no matter who you ask. In general, most people usually get to choose between having a high deductible or a high premium each month. And when something goes wrong, you’re on the hook for some of the cost. For example, if you’re hospitalized, your insurance might cover 100% of your first night’s stay — but they might only cover 50% of your second night’s stay, and so on. This is probably true no matter where your health insurance comes from (like the Marketplace or your employer).
If you don’t know your health insurance policy intimately well, you risk paying high out-of-pocket expenses in the event of a cycling-related emergency. Let’s dig into some common health insurance policy terms and then look for potential gaps in your coverage.
Health insurance premiums
This is what you pay every month for your health insurance. If you’re self-employed, you likely pay 100% of your premium directly to the provider. If you have employer-sponsored health insurance, a percentage of this is paid by your employer, and the remaining percentage is taken from your paycheck.
What cyclists should know:
If you have the same health insurance year after year, you might notice premium increases over time. If you’re constantly in and out of the emergency room for cycling injuries, your provider may charge you more per month to help cover these costs.
Health insurance deductible
This is how much you pay out-of-pocket per policy term, before your health insurance kicks in. Usually, you have a low deductible if you have a high premium and vice versa. Deductibles can range anywhere from $0 to tens of thousands of dollars. And if you share a plan with your family, there are two: one per person, and one for the whole family. You can usually find your deductibles on the first page of your policy documents.
What cyclists should know:
In short, your deductible is what you pay out-of-pocket before your insurance starts footing the bill. If you’re on a ride in January and are hit by a car, you’ll probably have to cover all the costs up to your deductible limit. If your deductible is $2,000, then you pay the first $2,000. And if it’s $10,000, then you pay the first $10,000.
Health insurance copay
This is what you pay for standard services like visiting your primary care physician, going to a specialist health care provider, or heading to the emergency room. For example, if your primary care copay is $50 per visit and you go to the doctor twice in the same month, you’ll pay $100 in copays. Most people also have pre-determined copays for medications.
What cyclists should know:
If you see a sports medicine specialist, you’ll have to pay a copay each time you pay them a visit. These costs can add up quickly if you choose a plan with high copays.
In-network healthcare provider
This is a doctor or medical professional who is contracted to work with your particular health insurance provider. The benefit of visiting an in-network physician is that your bills are usually much lower than they’d be if you went out of network.
What cyclists should know:
When Open Enrollment comes around, make sure you check that your favorite sports specialists and doctors are in-network before committing to a policy.
Out-of-network healthcare provider
This is a doctor or medical professional who isn’t contracted with your health insurance company. If you want or need to visit an out-of-network doctor, you can expect to pay much higher rates compared to an in-network professional.
What cyclists should know:
If you need to see a certain doctor for a knee injury (for example), if they’re out-of-network, you’ll pay a lot out of pocket each time you book an appointment.
Health insurance benefit limits
Your health insurance company offers benefits or things that are included in your coverage like physicals. But, there’s a limit to how many times you can go in a policy term (i.e. in a year) before the insurance company stops dispensing those benefits. If you pass that limit for a certain benefit, you pay for anything that’s leftover out-of-pocket.
What cyclists should know:
If you’re a commuter cyclist in a busy city, you may be more at risk for car accidents than the average bear. Every time you visit the hospital, you’re issued a blood test but there’s a limit on how many blood tests your health insurance pays for in a year. After you hit whatever that blood test limit is, you’re on the hook for 100% of the bill.
Different types of health insurance offer different benefits
Before we jump into how your cycling lifestyle might not be as covered as you think, let’s explore the different types of health insurance. First, most people usually have either a Preferred Provider Organization (PPO) or Health Maintenance Organization (HMO) plan. The biggest difference between the two is that:
- HMOs are more limited, but your costs are slightly lower
- PPOs give you more freedom, but your costs are slightly higher
Why does this matter to cyclists? Well, it matters because depending on the type of cyclist you are, one may cost you a lot more money than the other. For example, if you’re involved in a cycling crash and end up in the emergency room for a serious knee injury:
- With an HMO, you’ll have to get a referral to a knee specialist
- With a PPO, you can go to any knee specialist you want (with some limitations)
This especially matters if you’re a competitive cyclist who needs to recover quickly with the help of a sports injury specialist. On the other hand, this might not matter if you’re a casual cyclist who rides for fun on the weekends. There are pros and cons to both.
How cyclists can close gaps in coverage
Unfortunately, cyclists are more at risk for injury than a lot of other folks. Even though we pay a lot in health insurance each month, there are gaps in coverage. And by gaps, we mean benefit limits, out-of-pocket costs, and so on. Let’s explore this with an example.
- You’re a Floridian road cyclist but you’re on vacation in the mountains in Colorado
- You’re on a mountain trail and another rider doesn’t properly yield the right of way
- You’re forced off the trail and crash your bike into a tree leaving you with a few injuries
- You need to visit a doctor immediately
What does your health insurance cover? First, it’ll depend on whether you have a PPO or an HMO, and how close you are to your deductible. Let’s assume that it’s June, and you’re halfway through your $5,000 deductible. And remember, you’re in Colorado, so any doctor you visit probably isn’t going to be in-network. This means, at the very least, your blood tests, X-rays, and exams will all be paid with little to zero help from your insurance provider (up to $2,500).
So if you don’t have an extra several hundred or even a thousand bucks lying around, medical bills can be really scary. This is where your coverage gaps are. How do cyclists close this gap?
Gap insurance
People who have high deductibles may invest in supplemental, or gap, insurance. It gives you a little buffer between the high deductible and your out-of-pocket costs (i.e. it lowers the cost of what you pay before your deductible kicks in).
If we go back to the Colorado example from before, gap insurance could help lessen those out-of-pocket costs. But it probably won’t cover the bike’s damage, nor will it cover all of those medical costs.
Pros:
- Good for anyone with a high deductible health insurance plan
- Helps soften out-of-pocket costs
- You’re a frequent emergency room visitor
Cons:
- It’s another monthly cost that can be expensive
- You might not need it
- It’s not comprehensive coverage that’s designed for cyclists
Bicycle insurance
Bike insurance is supplemental insurance that’s specifically designed for cyclists and their bikes. Let’s go back to the Florida and Colorado example from before. If you had bicycle insurance, those out-of-pocket costs would be covered up to $10,000 with a medical coverage add-on. And, your bicycle would be repaired or replaced at its full value (or partial value if you chose to only cover a percentage of your bike’s value).
Plus, bicycle insurance policies start at just $8 a month. It fills in the gaps in your health insurance, and it gets you the coverage you probably wouldn’t get with gap health insurance. In addition, if you traveled to Colorado for a race and missed the event because your bicycle was damaged, Simple Bike Insurance would reimburse you for those nonrefundable event fees up to $500 per claim.
No matter what kind of cyclist you are, bicycle insurance fills in those gaps in your existing coverage. We protect you from theft, damage, and more — all for less than $10 a month for a basic policy. Easily add premium coverage for a few extra bucks each month to cover things like liability, medical bills, and even worldwide travel damage protection.
To see how much your bicycle insurance policy would be each month, get an instant quote now. It’s fast and it’s free, and it’s incredibly easy. Just enter in a few details about yourself and your bike, build your own policy, and you’re golden.