S/O Insurance--Deductibles

drillerswife

This probably makes me sound like an idiot, but I know nothing about deductibles. If I switch my health insurance I'll have a deductible--what counts toward meeting the deductible? What's covered before meeting your deductible (will I just have a copay for a routine visit, or is it different if the deductible hasn't been met yet)? Once you meet your deductible...then what? One part of the plan I'm looking at says "20% of allowed charges after deductible"---huh?

Can someone help me out here? Tell me what you know and talk to me like I know nothing because obviously, I don't.

jesseandbri

Regular visits do not go towards your deductible nor do prescriptions, if there is a copay the cost does not go towards the deductible.  Most of the time deductibles are related to the "expensive" type visits, ER, surgery, urgent care, etc.  After you pay the big lump sum of the $500 you will have to pay 20% of the remainder of the allowed charges.  Allowed charges are the charges that the insurance and provider agree to.  Hope that helps... I was logging back in to see if anyone else had any input on my post.  

SunnyDaze31

With my insurance, I just have a deductible to meet with no copays in-network. When I go to the doctor, I don't pay anything at the end of my visit. The doctor sends the bill to insurance, insurance tells them their negotiated rate/allowable charges for the procedures and the amount they cover ($0 till I meet the deductible), then the doctor's office sends me a bill me for this amount.

For me, any visit that isn't covered 100% counts towards my deductible, so basically anything except preventative exams. I've just met my yearly deductible for the 1st time ever...yay? I need to read my plan documents to learn what happens now- whether they cover 100% of the charges or just a percentage like in the plan at which you're looking.

5thOfJuly

Usually there's also a cap---so, you'd pay 20% up to a certain amount (like $5000/pp or $8000/per family.) After that you pay zero.

fuzzylogic

Don't have anything to add except that you shouldn't feel bad for not understanding some insurance things because I don't get it a lot of the time, either!

llizzyb

Lab work helped me meet my deductible super fast, as did some physical therapy visits. Any imaging, too. My deductible is $500. Say my MRI was $2,000....if I had that done in January, I would pay $500 out of pocket of it, plus 20% of the remaining $1500. Then my deductible would be met....so any other services like imaging, surgery, labs, etc. would cost me 20% of the total for the remainder of the year.

If you're like me, and have two surgeries in a year...that helps you meet not only your deductible but also your out of pocket max! I had a laparoscopy in May, and then hip surgery in July...hip surgery and the related costs were essentially free for me. 

I hope I explained that right. I can be a bit of a dunce with insurance b/c DH handles my medical bills. 

 

drillerswife

Thanks for the responses, ladies!  It just seems like it's more likely you end up paying more OOP when you have a deductible, but it looks like this is the route I'll end up going...

ShansBride

drillerswife:

Thanks for the responses, ladies!  It just seems like it's more likely you end up paying more OOP when you have a deductible, but it looks like this is the route I'll end up going...

When I was deciding whether or not we wanted a deductable plan, I decided that it would be less expensive as long as we don't go to the dr other than for well visits.  We don't have a copay with well visits, and we are generally a healthy family, so aside from the premium, it doesn't cost anything, as long as no one gets sick or hurt

This is the first time in years that we have met our deductable.

drillerswife

ShansBride:

drillerswife:

Thanks for the responses, ladies!  It just seems like it's more likely you end up paying more OOP when you have a deductible, but it looks like this is the route I'll end up going...

When I was deciding whether or not we wanted a deductable plan, I decided that it would be less expensive as long as we don't go to the dr other than for well visits.  We don't have a copay with well visits, and we are generally a healthy family, so aside from the premium, it doesn't cost anything, as long as no one gets sick or hurt

This is the first time in years that we have met our deductable.

I didn't think about it this way, good point!!