We know insurance can be confusing, so selecting a plan can be difficult! Hopefully this BORING but VERY IMPORTANT blog helps you with selecting a Health Insurance plan that is best for you!

This Blog will address the following:

(1) How to select the best Health Insurance Plan

(2) What insurances we are In-Network with for 2026 (including some new ones) and the general price range for PT based on those insurances

(3) Discounts? Do we give any?

(4) Who we recommend for Health Insurance Brokers

How to select the best Health Insurance Plan

1. First thing you need to know is that most health insurance plans restart Jan 1st of each year
   • This means your deductible, out-of-pocket, and visit limits will reset. So your cost for seeing medical professionals come January 2026 may be different compared to when you saw a medical professional in December of 2025.
   • Furthermore, some individuals will have a completely new insurance plan for 2026. It is the patient's responsibility to let providers know if and when their insurance changes. Not informing your provider can lead to medical expenses you were not expecting (due to denials or rate changes), but you as a patient are still responsible for. So please inform us of your health insurance for 2026 before the end of 2025 so we can begin updating our system! This way there are no surprises on either ends!
2. If you have an option to select a Blue Cross or Cigna plan, then you will want to be extra mindful of the type of plan you select!
   • COPAY Plans are the BEST plans to have!
     • Monthly premiums may be higher than deductible plans, but overall medical costs/expenses are always WAY cheaper for the patient. So if you go to any medical profession during the year with these plans, then you will have already saved money over the course of the year by having a copay plan vs a deductible plan - even if you just came to PT for just 2-3 visits! With copay plans, your costs are usually $10-60 per visit! So you are saving an average of $60-110 per PT visit compared to deductible plans! So, if you have the option for a copay plan, definitely go for it! Patients who have copay plans are rarely fearful of using their health insurance due to the low costs!!
   • Deductible & Co-insurance plans:
     • With deductible plans, you have to pay the full amount of medical expenses until your deductible is met. Once you have met your deductible, then you only have to pay a percentage of those expenses (co-insurance).
     • A Low Deductible Plan will have a higher monthly premium than a high deductible plan, and may cost the same (or less) than a copay plan. With a low deductible plan, if you plan to have a few medical expenses, then you will meet your deductible faster and spend less money overall in the year compared to a high deductible plan. If you came to PT for just 2-3 visits after you have met your deductible, then you will have already saved money over the course of the year by having a low deductible plan vs a high deductible plan. Most patients who have a low deductible plan are not fearful of using their health insurance because they know they will met that deductible fast and get more afforable services after meeting that deductible!!
     • A High Deductible Plan will have a lower monthly premium compared to all other plans. However, it is very unlikely you will meet your deductible unless you have something major medical happen. If you need any medical treatments, you will pay more over the course of a year with these plans compared to a copay or low deductible plan. If you do choose a high deductible plan, usually it is better to self-pay for medical expenses since self-paying is cheaper than using your plan's benefits. Self-paying for medical expenses can not be applied to your deductible; however, meeting your deductible is unlikely to begin with for high deductible plans. These plans are good for people who will not need anything more than regualr check-ups with their Primary Care Doctor. Most people who have a high deductible plans are fearful of using their health insurance, so hopefully our self-pay option helps lower those fears!
     • Regardless of your deductible amount, it is always best to meet your deductible in the start of the year, so everything medical is cheaper for the rest of the year! You end up saving more money in the long run compared to waiting to meet your deductible at the end of the year or self-paying. We hear from many patients that they wish they met their deductible earlier in the year so they could have had cheaper medical expenses for more than a few months at the end of the year. So get your physical therapy in sooner rather than later! But also, try to get in any other medical expenses in the start of the year (i.e. dermatology, yearly check-ups, etc.) so you can meet those deductibles sooner and have your insurance start working for you sooner!
3. If you have a Medicare Replacement/Advantage, the VA, Tricare Prime, UHC, Aetna, or a Healthshares/Metashare, then you can continue to use your same insurance and your price should not change into the new year.
4. If you have Medicare, ChampVa, or Tricare (all others - i.e. Select) then you can continue to use your same insurance and your cost will be different for your first visit (in order to hit your low deductible), but then back to the same price for all future visits. *For Medicare patients, your secondary may cover your Part B Deductible.*

What insurances we are In-Network with for 2026 (including some new ones) and the general price range for PT based on those insurances

**Prices are determined by health insurances, not us**

1. Blue Cross
   • If you are on a coinsurance plan, and you have not met your yearly medical deductible, then prices usually range between $115-130 per visit (varies based on plan types). Once you've met your deductible, then your visit cost is a percentage of that $115-130 per visit cost, based on your co-insurance. Example: 10% co-insurance = $120x10% = $12 per visit.
   • If you are on a copay plan, then you only pay whatever your copayment is.
2. Cigna
   • If you are on a coinsurance plan, and you have not met your yearly medical deductible, then prices usually range between $113-125 per visit (varies based on plan types). Once you've met your deductible, then your visit cost is a percentage of that $113-125 per visit.
   • If you are on a copay plan, then you only pay whatever your copayment is.
3. Medicare
   • Free if you have met your Part B Deductible, have a secondary insurance, and have a referral. If you secondary does not cover your Part B Deductible, then usually your first two visits have a payment before it is free.
4. Medicare Replacements
   • Humana Medicare, Aetna Medicare, UHC Medicare, Devoted, Capital Disctrict, etc.
   • These plans widely vary in price, so we usually have to call your plan to know your costs. Most of these plans are on a copay plan, so your cost is usually less than $50 per visit.
5. VA 
   • Free once the VA approves you for PT and you have a referral.
6. ChampVA
   • If you have not met your yearly medical deductible, then your first visit is usually $70 or less. Once you've met your deductible, then your costs are $30 per visit.
7. Tricare Prime
   • Free once Tricare approves you for PT and you have a referral.
8. Tricare All Others
   • If you have not met your yearly medical deductible, then your first visit is that deductible amount.   Once you've met your deductible, then your costs are $25 per visit.
9. AmBetter
   • We will be in-network with them come Nov 1st!! Once we are in-network, then we will know the price breakdown.
10. WellCare
    • We will be in-network with them come Nov 1st!! Once we are in-network, then we will know the price breakdown.

With all these plans, we still do not upcharge for evaluations, dry needling, Blood Flow Restriction Training (BFR), 3D Running Analysis, Scraping, Cupping, etc. like other clinics. What you need is what we will provide! We always try to bill and charge on the lowest side possible for our patients! Our goal will always be focused on getting you Better, Faster!

Discounts? Do we give any?

We offer a 50% discount for Law Enforcement, Fire Services, DNR, and EMS! It is our way of giving back to those who do so much for us! 

This also applies to their immediate family members (spouse & kids under the same health insurance) and any staff working within these departments! 

Spread the word!!

Who we recommend for Health Insurance Brokers

Did you know that using a health insurance broker is FREE for you!!! Brokers are available to help you understand your health insurance needs, and then sign you up for the best plan based on your needs?!

The below brokers have had a history of being a huge help for many of our patients! They help individuals find legit health insurance plans (i.e. Blue Cross, Medicare, Medicare Replacements, etc.) with low monthly premiums, but still with amazing coverage!!

• Bryan Farley
  • C&K Benefits
  • P = 864-993-1089
• Jorge Lara 
  • Onguard Insurance Company
  • P = 864-905-8518

When you speak with them, let them know you are a patient of Purposed Physical Therapy, and they can help make sure you get a plan that covers you the best for Physical Therapy as well!

We hope this boring Blog was helpful! Thank you for being a part of our community 😁

If you have pain or limitation and live in Greenville-Spartanburg SC, then call the rehab experts at Purposed Physical Therapy at (864) 881-1712 or you can fill out our New Patient Form by clicking HERE and we will call you!