Can someone explain how medical insurance deductible and max out of pocket work?

Question

my ded. is $1000 and my max out of pocket is $7000 for family

Answer 1

Deductible is simply what you pay out of your pocket before the insurance plan starts paying on covered medical procedures or drugs(unless they have a separate deductible).After you reach your deductible (or so many in the family reach it)then the insurance company starts paying a percentage of your medical bills , you pay the remaining percentage  until the $7000 has been reached and then the plan pays 100% until it reaches the lifetime maximum.The $7000 usually needs only two in the family to reach it, the others don't have to reach it, only there deductible has to be reached.

Answer 2

Deductibles are what you have to pay before the insurance pays.  (The deductible may not always apply to a dr. visit you might have a co-pay... which is an amount you pay (such as $30) every time you go to the dr. and the deductible is waived). Co-pays do not apply toward your deductible.

For example, if you go to the hospital for something... you have $1000 deductible... you are going to pay the 1st $1000 of your expenses, and then you will have coinsurance (20% usually) that you pay on top of that.

So, if your hospital bill is $9800, you pay $1000 for your deductible, and the balance is $8800,  if you have an 80/20 plan, the ins co pays 80% of the $8800 and you pay the remaining 20%.  

Family means if you have you your spouse and children on the policy, the maximum you will pay out of pocket annually is $7000.  Then the policy will pay 100% after that amount.

How do you get to the $7000 if your deductible is only $1000?

1.  You, your spouse, and your child(ren) have separate deductibles.  It is probably $1000 per person, with a family deductible of some sort probably $2000 or $3000.

2.  After the $1000 per person, you pay 20% for everything and the company pays 80%.   (If you have an 80/20 plan)

So you have your $1000 deductible plus 20%

and your spouse and children have their deductible(s) plus 20%, and if you reach the $7000 between all of you, then you pay no more the insurance company then picks up 100%.