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    • Mammogram
    • Women's Health
    • Cancer Care

    Ladies! Get Screened for Breast Cancer

    Early detection is a significant piece of the breast cancer puzzle. Susan Cox, Renown Health Senior Director of Cancer Operations, discusses what you need to watch for and how the latest technology can help detect potential cancer sooner. When should women start getting breast exams? It depends on risk factors: Average-risk women: Most medical organizations recommend the first mammogram between 40 and 44. Higher-risk women: Dependent on their high risk, which will dictate when they start screening, but generally around the age of 30 and not before 25 years old.

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    • Women's Health
    • Mammogram

    Do Mammograms Hurt? 4 Myths Debunked

    Mammograms are an effective means for early detection of breast cancer. Still, many women shy away from them for fear of pain or discomfort. Let us debunk a few mammogram myths that will remove your worries and encourage proactive breast health. Reviewed by Dr. Colleen O'Kelly-Priddy, MD, FACS, breast surgical oncologist at Renown Women's Health. Myth 1: Mammograms Are Painful Reality: Although some women experience discomfort during a mammogram, most say it is not painful. Breast compression, which is important to get a clear image, can cause a sensation of pressure, but this lasts for a few seconds. Let your technician know how much pressure you can handle so you're not uncomfortable. Myth 2: Discomfort Persists Long After the Procedure Reality: The sensation of pressure developed through the compression process diminishes quickly after the procedure. Most women go about their day afterward without experiencing any residual pain.

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    • Women's Health
    • Cancer Care
    • Mammogram

    7 Symptoms of Breast Cancer in Young Women

    Cancer can develop at any age, and that’s why the experts at Renown are ready to help you stay ahead of breast cancer, especially if you're in your 20s or 30s. We're talking about early detection, signs to be aware of, and why being proactive is a big deal. Studies show there has been an increase in breast cancer in younger women. Although breast cancer is rare in women under 40, when it occurs, it tends to be aggressive. The tricky part? Many young women don't think it can happen to them, so they don't check for the signs as often as they should. Reviewed by Dr. Colleen O'Kelly-Priddy, MD, FACS, breast surgical oncologist at Renown Women's Health. Early Signs and Symptoms New or Different Lump in the Breast: A lump is probably the most well-known symptom. Breast cancer is usually painless and firm, but it can also be soft. If you find a new lump, don't panic, but don't ignore it either. Changes in Breast Size or Shape: Have you noticed that one breast looks a little different? Whether it's swelling, shrinking, bulging, dimpling, or seems off, it's worth mentioning to your doctor. Skin Changes: If the skin on your breast starts to thicken or turn red, it's time to pay attention. If your skin starts looking like an orange peel (thickened, with prominent pores), that warrants evaluation. Nipple Discharge: Spontaneous drainage coming from your nipple that isn't breast milk—especially if it's clear or bloody—should be checked out. Nipple Changes: If your nipple starts to invert, flatten, or look different, call your doctor. Breast Pain: Continuous pain in your breast or nipple that isn't linked to your menstrual cycle is another symptom to note. However, breast pain is very common and is only rarely a sign of cancer, so don’t panic. Swelling or Lumps in the Armpit: When it spreads, breast cancer usually first goes to the lymph nodes in the armpit, so swelling or lumps under your arm should be on your radar.

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    • Student Programs
    • Nursing
    • University of Nevada, Reno
    • Renown Health
    • Renown Health Foundation

    Meet Future Renown Nurse Jeromy Hughes

    When Jeromy Hughes became one of the 29 nursing students accepted into the first Gerald “Jerry” Smith Academic-Practice Partnership cohort, he almost couldn’t believe it. Life as both an Orvis School of Nursing student and a future nurse in our community was about to change. Not only was he about to receive full tuition support, but he also was set up for a guaranteed start to his career as a nurse at Renown Health.   The Academic-Practice Partnership was named in honor of Jerry Smith of the Nell J. Redfield Foundation. Supported by a generous gift from the Redfield Foundation and Stephanie Kruse, Foundation Board Director, the goal of this partnership is to help foster a lasting nursing workforce in northern Nevada, with nurses like Jeromy leading the charge.  From the Courtside to the Bedside Jeromy grew up playing basketball in his hometown of Las Vegas and was on the team at Bishop Gorman High School. His talent resulted in a scholarship to play basketball for Wenatchee Valley College in Washington, which would put him on a trajectory to play professionally – even though nursing was always in the back of his mind. Jeromy received a unique opportunity to play for De La Salle University in the Philippines, and with much excitement, he set off across the world.  Then, the COVID-19 pandemic hit.  When the world shut down, Jeromy had no choice but to stay in the Philippines, waiting to return to the Silver State. Three months later, he flew home to Las Vegas.  In those moments, Jeromy’s entire mindset shifted. A career in nursing was no longer in the back of his mind; it came right to the forefront. With a plan to now stay in-state, he set off to attend the University of Nevada, Reno (UNR).  “My whole family is involved in the healthcare field, and I’ve always been surrounded by healthcare in some way,” said Jeromy. “My parents own an elder care facility, my dad is a respiratory therapist in Las Vegas and my grandparents own a hospice facility down in southern California. My grandma was also a nurse for more than 50 years, and throughout her career, she worked in labor and delivery, psychiatry and medical-surgical units. I’ve always wanted to help people like my family has, and nursing resonated with me the most out of every option.”

    Read More About Meet Future Renown Nurse Jeromy Hughes

    • Cancer Care
    • Mammogram

    Guide to Cancer Screenings

    One of the most crucial aspects of maintaining health and wellness is staying proactive about regular cancer screenings. Early cancer detection significantly increases the chances of successful treatment and survival. The multidisciplinary care team at the William N. Pennington Cancer Institute at Renown Health provides compassionate care and support to the community for early detection and diagnoses. This comprehensive guide outlines the various cancer screenings available for breast, colorectal, lung, cervical, prostate and skin cancer. Breast Cancer Screening Who Should Get Screened? Mammograms are recommended starting age 40 for those considered at average risk for breast cancer. Women with a family history or other risk factors should discuss appropriate screening options with their healthcare provider. Women under 40 with a family history should discuss risk factors with a healthcare provider. Screening Methods Mammogram: This provides an X-ray of the breast and can detect tumors that are not yet palpable. Breast MRI: This type of scan is recommended for women at high risk for breast cancer due to genetic factors or family history. Screening Breast Ultrasound: This scan can help in identifying masses in denser breast tissue that might not be visible on mammogram. It is recommended in addition to a mammogram for patients at a higher risk for breast cancer. What to Expect During a mammogram, the breast is compressed between two plates to capture X-ray images. Some pressure or discomfort may be felt, but the procedure is brief and critical for early detection. Colorectal Cancer Screening Who Should Get Screened? Adults aged 45 to 75 should undergo regular colorectal screenings. Some adults under 45 may need to be screened earlier depending on family history or other genetic risks. Those over 75 should consult with their healthcare provider to determine if continued screening is necessary. Screening Methods Colonoscopy: This procedure uses a flexible tube with a camera to examine the entire colon. Fecal Immunochemical Test (FIT): A non-invasive test that detects hidden blood in the stool. CT Colonography (Virtual Colonoscopy): Uses Computed tomography (CT) imaging to provide detailed views of the colon. What to Expect A colonoscopy can detect changes or abnormalities in the large intestine (colon) and rectum. Screening is usually advised every ten years, but if you are at risk, screening may be recommended every 3 to 5 years after your initial colonoscopy. Colonoscopy preparation includes bowel cleansing the day before and sedation during the procedure. FIT is a simple at-home test requiring no special preparation. Lung Cancer Screening Who Should Get Screened? Adults aged 50 to 80 with a significant smoking history (20 pack years or more) and who currently smoke or have quit within the past 15 years. Screening Methods Low-dose Computed Tomography (LDCT): A CT scan with low radiation doses to create detailed images of the lungs. What to Expect LDCT is a non-invasive scan that requires you to hold your breath for a few seconds. Cervical Cancer Screening Who Should Get Screened? Women aged 21 to 65 should undergo regular screenings. Women aged 21 to 29 should have a Pap test every three years. Women aged 30 to 65 should have a Pap test and HPV test every five years, or a Pap test alone every three years. Screening Methods Pap Test (sometimes called a Pap Smear): Collects cells from the cervix to detect precancers. HPV Test: Identifies high-risk human papillomavirus (HPV) types that can cause cervical cancer. What to Expect The Pap test involves collecting cells from the cervix using a small brush. Some discomfort may be felt, but the procedure is brief and crucial for early detection. Prostate Cancer Screening Who Should Get Screened? Men aged 50 and older should discuss screening options with their healthcare provider. Men at higher risk (African American men and those with a family history of prostate cancer or are a BRCA2 gene carrier) should begin discussing screenings  at age 40. Screening Methods Prostate-Specific Antigen (PSA) Test: Measures PSA levels in the blood. Digital Rectal Exam (DRE): A physical examination where the provider feels the prostate through the rectum to detect abnormalities. What to Expect The PSA test is a simple blood test. The DRE may cause slight discomfort but is quick and essential for early detection. Skin Cancer Screening Who Should Get Screened? Anyone with a suspicious lesion or abnormal area on their skin. Individuals with more than 50 moles or dysplastic moles. Those with a personal history of melanoma or history of other skin cancers. Those who have more than one member of immediate family with a history of cancers (melanoma, breast cancer, pancreatic cancer) or a family member who was diagnosed with melanoma before they were 50 years old. Positive gene testing for BRACA2, Lynch syndrome genes (MLH1, MSH2, MSH6, PMS2 or EPCAM). Screening Methods Skin Exam: A visual examination by your provider to check for unusual moles, birthmarks, or other skin changes. Biopsy: Removal of a small sample of skin for testing if an abnormal area is identified. What to Expect A skin exam is non-invasive and visual. A biopsy involves minor discomfort and local anesthesia if needed. Expert Advice Although the cadence of these skin screenings may or may not be annual, as one's age increases, the risk of many cancers rises. Everyone benefits from attentive sun protection, including avoiding direct sun between 10 a.m. and 4 p.m. by seeking shade and wearing hats, clothing and sunscreen. When purchasing sunscreen, look for SPF 50, UVA/UVB broad spectrum. Questions to Discuss with Your Healthcare Provider What is my risk level for different types of cancer? Which screening tests do you recommend for me and why? What are the potential risks and benefits of each test? How often should I get screened? What steps to follow if a test result is abnormal? Importance of Cancer Screenings Regular cancer screenings are vital for maintaining your health and catching cancer early, when it is most treatable. Renown Health is dedicated to guiding you through the process and providing the highest quality of care. Consult with your healthcare provider to determine the appropriate screenings for your specific needs and to take proactive steps toward a healthier future.

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    • Surgical Services
    • Weight Loss
    • Obesity
    • Patient Story

    A Transformative Journey: Mary's Bariatric Surgery Story at Renown Health

    Embarking on the path to bariatric surgery is a unique and deeply personal journey. Individuals like Mary Escobar choose this life-changing route for reasons ranging from improved cardiovascular health to managing diabetes or finding relief from various health complications. In Mary's case, her two-decade-long healthcare journey not only underscores the challenges she faced but also highlights the support and expertise that ultimately led to her successful transformation through bariatric surgery. Mary's Resilience: December 2002 through February 2003 More than two decades ago, Mary experienced unforeseen health complications just days after giving birth via c-section. Septic shock, hemolytic uremic syndrome, thrombocytopenia, renal failure and a blood clot in her lung plunged her into a critical state. Intensive care, plasma exchange and a long recovery followed. After being discharged with compromised kidney function, Mary faced complete renal failure two years later, leading to dialysis and a spot on the donor list. Mary's brother, a perfect match, selflessly donated his kidney on Dec. 14, 2007, marking a turning point in Mary's health. However, the post-transplant period brought new challenges, including diabetes, high blood pressure and a significant weight gain, reaching 230 pounds. Determined to regain control, Mary explored various diets without success until she consulted with a bariatric doctor. Journey to Bariatric Surgery: November 2009 - April 2021 In November 2009, Mary opted for a gastric band, shedding 40 pounds within a year. Despite initial success, issues with the gastric band arose, prompting a consultation with Dr. John Ganser at Renown Health in April 2021. Together, they decided to transition to a gastric sleeve, with comprehensive education provided to ensure long-term success.

    Read More About A Transformative Journey: Mary's Bariatric Surgery Story at Renown Health

    • HealthyNV Project
    • Research and Studies
    • Mammogram
    • Genetic
    • Cancer Care

    Optimizing Mammogram Screenings: A Genetic Approach to a Personalized Screening Schedule

    © Arthon Meekodong via Canva.com Breast cancer screening has long been a cornerstone of women's healthcare. With 1 in 8 women diagnosed with breast cancer in their lifetime1, the United States Preventive Services Task Force (USPSTF) has developed screening recommendations to help detect early-stage cancer. Notably in 2023, the USPSTF revised the recommended age for biennial mammogram screenings for women with average risk to start at age 40 instead of 502, estimated to result in 19% more lives being saved3 by starting screening earlier. While initiating screening at an earlier age offers advantages to a wide demographic, concerns about the potential of over-screening prompted research into the feasibility of identifying women with lower breast cancer risk who could safely delay mammograms. While guidelines address high-risk individuals, a notable gap exists in providing recommendations tailored to those at lower risk. To gain insight into a patient's risk level, physicians are able to utilize genetic testing to understand an individual's genetic makeup, providing precise insights into their predisposition to various health conditions, including breast cancer. Armed with this genetic information, healthcare providers could craft tailored screening strategies that align with an individual’s specific risk profile. This genetic risk-based approach underscores the value of genetics in individualizing the onset of screening to help avoid over-screening and its associated costs. Surprisingly, genetic information is not currently being widely utilized to identify women at risk of breast cancer or other diseases in clinical practice, despite its potential to make a significant positive impact for patients. A recent retrospective analysis of 25,591 women from the Healthy Nevada Project4 sheds light on the potential benefits of this genetic risk-based approach. The study classified 2,338 (9.1%) of these women as having a low genetic risk for breast cancer. What's remarkable is that these women exhibited a significantly lower and later onset of breast cancer compared to their average or high-risk counterparts. This finding suggests that it might be safe for low-risk women to delay mammogram screening by 5 to 10 years without compromising their health.

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    • Expert Advice
    • Obesity
    • Surgery
    • Weight Loss

    Strategies for Lasting Weight Loss

    Managing weight is a complicated and often difficult journey for many individuals, and obesity stands as a common and serious chronic health condition. In fact, the Center for Disease Control and Prevention reports that the prevalence of obesity in the US is greater than 40% in adults and 20% in children, and those numbers are continuing to climb. In Nevada, according to the 2020 Behavioral Risk Factor Surveillance System, 28.7% of adults reported being obese. By 2030, almost 80% of American adults may be overweight and half of them will be obese. But obesity isn't just about the numbers on the scale; it's a multifaceted, lifelong, neurobehavioral disease triggered by a combination of factors. These include abnormal eating patterns, reduced physical activity levels, environmental stressors, genetics and various other contributors. Obesity extends far beyond appearance, often leading to the development of numerous medical conditions such as diabetes, heart disease, elevated blood pressure, stroke, sleep apnea, liver disease, various cancers and infertility. Join us as we delve into the complexities of obesity and explore strategies for effective weight management available right here in northern Nevada. Why Can Losing Weight be so Difficult? The challenge behind weight loss finds its roots in the Set-Point Theory of Obesity, a concept that says our bodies have a predetermined weight, or fat mass, within a defined set-point range. In other words, when an individual's weight deviates from this set point, the body initiates mechanisms to bring it back to the established range. So, if someone loses weight below their set point, the body may respond by increasing hunger and reducing metabolism, making it challenging to sustain weight loss. There Isn’t One Right Answer, But Renown is Here to Help Various weight management strategies can be utilized by patients struggling with obesity, which may lead to substantial weight loss, resolution of associated medical conditions and improved psychosocial health. In fact, the most successful strategy involves a multidisciplinary approach under the guidance of trained specialists that includes a combination of tactics, including: Behavioral adaptations Dietary modifications Physical exercise  Anti-obesity medications  Weight loss surgery

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    • Employees
    • Professionals
    • Renown Health

    Department Spotlight: Marketing and Communications

    Nov. 12-18 is Health Care Strategy & Market Development Week. Please join us in celebrating the Marketing and Communications team at Renown Health!  When you think of the brand of Renown Health, what comes to mind? Perhaps you think about our Fight the Good Fight motto that you see integrated throughout our commercials and advertisements. Or maybe your mind drifts to our signature purple that you saw on a print design or social media post. You may even think of a local news story that showcases the essence of who we are as an organization. Or you may gravitate toward the look and feel of our patient-friendly website. Managing the brand of our health system is crucial as patients look to Renown to be the voice of not-for-profit healthcare – and it takes a wide range of expertise to solidify that voice.  The masters of our voice can be found within Renown’s Marketing and Communications (“MarComm”) team. From branding and business-to-business to content and community relations, this robust department is the minds behind our reputation within the communities we serve. This team is chock-full of expert writers, speakers, designers and marketers who craft positive and memorable communications that lead to a lifetime of patient and employee loyalty.  The Connoisseurs of Communicating  As the keyholders of Renown’s brand position and promise, our MarComm team are experts at ensuring the community at large remembers precisely who Renown is and what our health system stands for. This all-hands-on-deck department encompasses a wide variety of talents:  Marketing and creative services: Traditional and digital advertising, brand templates and collateral and brand image and awareness Communication and public relations: Employee and provider communications, intranet management, social media, media relations, photography and videography, community relations, crisis communications and strategic planning and advisement Digital specializations: Website and microsites, email marketing, customer journey mapping, blogs and chatbots  Our Marketing and Creative Services team members are the ultimate dreamers, starting diverse campaigns from the ground up.  “In marketing and creative services, we are always dreaming up something new,” said Emily MacMillan, Manager of Marketing & Creative Services. “Between our brand advertising, to service line campaigns to external partnerships, you can always find our team working on a marketing plan and creating ads, content, messaging, videos, graphics, emails, photoshoots and more.”  “From Fight the Good Fight brand work to a service line promotion or a sponsorship creative package, the variety of projects my role allows me to bring to life for Renown is almost endless,” added Chad Norton, Senior Creative Specialist. “That can make every day at my job nothing like the day before – which keeps things interesting and my creativity flowing.”  For all things storytelling and public image management, Renown looks to the Communications team for expert guidance.  “As the Manager of Communications, I get to lead the most talented group of professionals I have ever had the pleasure of working with,” said Caroline Ackerman, Manager of Communications & Public Affairs. “Sometimes there is an urgent matter to tend to, and we drop everything to support larger-scale communications. Other days, we get last-minute requests from our local media partners for TV interviews. On top of that, the communications team supports event planning and employee recognition. It’s so fun to work in this hybrid space where we can get our work done from home while also being present at meaningful Renown events.”  At Renown, we believe our external image is just as vital as our internal culture. Keeping our employees informed and engaged every step of the way is of utmost importance to MarComm.  “While most of our department supports projects that focus on our patients, guests and visitors, our employee communications team supports internal clients (our employees),” said Dani Vogel, Communications Business Partner. “Therefore, I spend a good portion of my time working with internal departments and service lines to deliver important communications across the organization using a variety of channels. In a nutshell, my day starts with the question, ‘what do our employees need to know today?’ We get to work with so many amazing internal teams.”  “I internally project manage some of the marketing campaigns, from open enrollment to our annual report, and each project is different and requires its own approach,” added Colleen McLellan, Senior Production Specialist. “I create the framework for each project, such as establishing a kickoff and ongoing meeting cadence during the project, ensuring we track lessons learned and decisions made for each, create the folder structure in Sharepoint, and opening a project and maintaining the tasks and deadlines in Workfront. I am also often part of a quality circle, proofing ads and other materials created as part of a campaign. As with all of my colleagues in MarComm, we are often resources for where to learn more or find information for other departments.”  “One of my roles is to maintain the Brand HQ site and review approval requests,” added Aurora Boles, Creative Services Specialist. “I enjoy hopping on Teams calls to assist our employees with their questions about the site or templates.”  Maintaining a high standard of digital excellence comes easy for the Marketing Technology team, who manage the complexities of Renown’s digital front door – starting with our website.  “Think about how many health service lines Renown has to offer; now, let's create an organized set of pages for that specific service line on Renown.org – that a lot of pages!” said Sarah LaBarge, Digital Specialist. “It takes time to curate the layout, work with providers and the Communications team to ensure the content is correct and create components and images for the page to give the user the best digital experience while continually updating and maintaining all our pages. We don't just have Renown.org; we have many other microsites that we maintain as well. It is a nice challenge to make both our team and users happy and have a good experience.” "The user experience is always at the forefront of whatever I do," added Tori Bowlin, Digital Content Editor. "When writing health blogs, emails, or health service web content, it's essential to attribute the information to one of our outstanding providers and link the post to a Renown Health Service or reputable source. A thoughtful workflow helps our customers make informed decisions regarding their health and well-being." As a not-for-profit health system, Renown reinvests right back into the community we serve. Our Community Benefit team serves as the overseers of this promise, ensuring our local non-profits that share our mission are able to deliver on their own goals.  “I absolutely love the role of community impact and partnership liaison and the opportunity it provides to work with so many wonderful local nonprofits,” said Melissa Dahir, Community Benefit Liaison. “Our local community is filled with so many organizations designed to help those in need, and it is an honor to be contributing to and supporting the work these amazing groups do. My work with this department involves partnering with nonprofit organizations by providing funding for program support through groups identified in our Community Health Needs Assessment, and providing grants for traditional events such as community walks, golf tournaments, dinners, galas and more.”  The MarComm team’s paramount focus on maintaining a caring and collaborative culture stems from the impact they have on patients' lives and the crucial trust placed in the organization. For this team, no project to benefit the health and well-being of Renown’s patients is too big nor too small.  “As someone holding a core leadership position on this team, I can see firsthand that our team is all about culture and retention,” said Cristal Woodley, Senior Director of Marketing, Communications and Customer Engagement. “At the end of the day, we have an impact on patients’ lives and trust in the organization. I’ve surrounded myself with such smart people.”

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    • Renown Health
    • Health Insurance and Coverage

    Health Insurance Terms Explained: HMO, EPO and PPO Plans

    When it comes to purchasing a health insurance plan, you’ve probably heard of the two plan types, HMO and PPO, but what exactly do these terms mean, and what is an EPO? Let’s learn more about these plan types and how you can choose the plan that meets your needs. What is an HMO Plan? HMO stands for “Health Maintenance Organization.” HMO plans contract with doctors and hospitals creating a network to provide health services for members in a specific area at lower rates, while also meeting quality standards. HMO plans typically require you to select a primary care physician (PCP) and obtain a referral from your PCP to see a specialist or to have certain tests done. If you choose to see a provider outside of the HMO’s network, the plan will not cover those services and you will be responsible for all charges. What is an EPO Plan? An EPO stands for “Exclusive Provider Organization.” This plan provides members with the opportunity to choose in-network providers within a broader network and to visit specialists without a referral from their primary care doctor. EPO plans offer a larger network than an HMO plan but typically do not have the out-of-network benefits of PPO plans. EPO plans do not require you to select a primary care physician (PCP) giving you a broader network of providers. EPO options are a great cost-saving option with more flexibility than a standard HMO plan. What is a PPO Plan? PPO stands for “Preferred Provider Organization.” PPO plans are often more flexible when it comes to choosing a doctor or a hospital. These plans still include a network of providers, but there are fewer restrictions on the providers you choose. PPO plans do not require you to select a primary care physician (PCP), giving you a broader network of providers. So, which plan should you choose? Each plan type has different benefits, so it depends on your health needs when choosing the right plan type. If you are looking for flexibility when choosing providers and locations, a PPO plan may better fit your needs. An EPO plan may be a better option if you want the flexibility of a larger network, but don’t necessarily need out-of-network benefits. If you regularly seek care in a certain geographic area and are looking for a health insurance plan at a lower price point, consider an HMO plan. To keep costs low, insurance carriers contract with providers and partner in plan members’ health to ensure quality care at the lowest cost. Whether you choose an HMO, EPO or PPO option, partnering with your health insurance carrier and your healthcare provider will help you receive the best care while controlling your out-of-pocket costs. Keep in mind that most insurance carriers offer emergency care coverage for all three plan options (HMO, PPO, EPO). Get the most out of your health insurance benefits! Established in 1988, Hometown Health is the insurance division of Renown Health and is northern Nevada’s largest and only locally-owned, not-for-profit insurance company providing wide-ranging medical coverage and great customer service to members.

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    • Health Insurance and Coverage

    Health Insurance Terms Explained: Deductible and Out-of-Pocket Maximum

    Health insurance might be one of the most complicated purchases you will make throughout your life, so it is important to understand the terms and definitions insurance companies use. Keep these in mind as you are comparing health insurance plan options to choose the right plan for you and make the most of your health insurance benefits. One area of health insurance that can cause confusion is the difference between a plan's deductible and out-of-pocket maximum. They both represent points at which the insurance company starts paying for covered services, but what are they and how do they work? What is a deductible? A deductible is the dollar amount you pay to healthcare providers for covered services each year before insurance pays for services, other than preventive care. After you pay your deductible, you usually pay only a copayment (copay) or coinsurance for covered services. Your insurance company pays the rest. Generally, plans with lower monthly premiums have higher deductibles. Plans with higher monthly premiums usually have lower deductibles. What is the out-of-pocket maximum? An out-of-pocket maximum is the most you or your family will pay for covered services in a calendar year. It combines deductibles and cost-sharing costs (coinsurance and copays). The out-of-pocket maximum does not include costs you paid for insurance premiums, costs for not-covered services or services received out-of-network.  Here's an example: You get into an accident and go to the emergency room. Your insurance policy has a $1,000 deductible and an out-of-pocket maximum of $4,500. You pay the $1,000 deductible to the hospital before your insurance company will pay for any of the covered services you need. If you received services at the hospital that exceed $1,000, the insurance company will pay the covered charges because you have met your deductible for the year. The $1,000 you paid goes toward your out-of-pocket maximum, leaving you with $3,500 left to pay on copays and coinsurance for the rest of the calendar year. If you need services at the emergency room or any other covered services in the future, you will still have to pay the copay or coinsurance amount included in your policy, which goes toward your out-of-pocket maximum. If you reach your out-of-pocket maximum, you will no longer pay copays or coinsurance and your insurance will pay for all of the covered services you require for the rest of the calendar year.

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    • Health Insurance and Coverage

    Copays vs. Coinsurance: Know the Difference

    Health insurance is complicated, but you don't have to figure it out alone. Understanding terms and definitions is important when comparing health insurance plans. When you know more about health insurance, it can be much easier to make the right choice for you and your family. A common question when it comes to health insurance is, "Who pays for what?" Health insurance plans are very diverse and depending on your plan, you can have different types of cost-sharing: the cost of a medical visit or procedure an insured person shares with their insurance company. Two common examples of cost-sharing are copayments and coinsurance. You've likely heard both terms, but what are they and how are they different? Copayments Copayments (or copays) are typically a fixed dollar amount the insured person pays for their visit or procedure. They are a standard part of many health insurance plans and are usually collected for services like doctor visits or prescription drugs. For example: You go to the doctor because you are feeling sick. Your insurance policy states that you have a $20 copay for doctor office visits. You pay your $20 copay at the time of service and see the doctor. Coinsurance This is typically a percentage of the total cost of a visit or procedure. Like copays, coinsurance is a standard form of cost-sharing found in many insurance plans. For example: After a fall, you require crutches while you heal. Your coinsurance for durable medical equipment, like crutches, is 20% of the total cost. The crutches cost $50, so your insurance company will pay $40, or 80%, of the total cost. You will be billed $10 for your 20% coinsurance.

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