Health insurance deductable?

Question

OK- the insurance i want to start is a 2000 dollar deductable- 1000 me 1000 my husband. Ok , say i go to the ob/gyn and thats 20% coininsurance it says- do i need to pay insurance 1000 ahead of time? when do you need to pay insurance 1000? i am really confused

Answer 1

You're going to have to pay your contracted rate. Depends on the type of insurance you have. Say you have Blue Cross, and the Dr. charges you $90... You'll pay whatever BC has agreed is the allowable for this charge (if it's $60, you pay $60 and the doctor writes off $30). You'll pay the allowed amount until your deductible is met. Then it should go to your 20% copay amount.

Answer 2

Definition: The amount of money the insured patient must pay out-of-pocket before the insurance company must begin paying benefits. Some services, like doctor visits, may be available without meeting the deductible first.

For example, if there is a $500 deductible, the insured patient must pay for the first $500 of healthcare expenses before the insurance company will begin paying claims.

Answer 3

Hi. To add something to the previous answer, please let me explain in some detail.

I always tell my customers there are several very important things to consider when buying health insurance.

Co-payments (or co-pays)

Deductibles

Coinsurance

Maximum-out-of-pocket

Some policies - have no coinsurance. A doctors visit might be a $25 co-pay, and the insurance company would pay for the rest for the appointment. Some insurance companies even pay for all the blood work. If you have co-pays, you need not be concerned about paying the deductibles first for those services.

If that same person ended up at the hospital for the average $25,000 stay, the insured would likely have to pay the deductible first - lets use $1500 - and the insurance company would pay for the rest. In this case, the Maximum-Out-Of-Pocket equals the deductible - $1500. Once you've paid that much in a calendar year, you are done!

Now, lets say that someone has a deductible AND coinsurance. In that previous hospital example, you would again have to pay the deductible first - lets use $1500 - and then you would still have to pay some coinsurance after that. Lets say you have a 20% coinsurance clause and a Max-Out-Of-Pocket provision of $2000.

In that case, you would pay the $1500 deductible, and then 20% of the costs after that until you reached you Max-out-of-pocket of $2000. So, when your total bill hit $4000, you would have paid 1/2 and your insurer 1/2. Only now would they would pay the rest.

First $1500 was yours

The next $2500 in medical bills was shared - you paid 20% or $500, and the insurance company paid 80% or $2000.

At this point, you've each paid $2000, but you are done! You've reached your Max-Out-Of-Pocket and the insurer pays the rest.

I can pretty much guarantee you your policy will be exactly like this, with different numbers that you must plug in. I have seen the Max-Out-Of-Pocket as high as $15000!!

If you have something like that, the cost of your medical insurance should be quite low. More typical is a Max of $2500 or $5000. This is still in the reasonable range for consumers.

Getting the right insurance for your money always means working with a good agent who understands your budget and

gets you the most coverage possible for that amount of money. Most independent agents have access to hundreds of different policies, due to relationships with several companies that may offer 50 different policies each!

Different deductibles, coinsurance amounts, Max amounts, co-pays ------everything. The experienced agents know the best policies for value, and that's all they will sell. I hope you had a good one!

To make sure, you might want to deal with the largest health insurance companies out there. I think BlueCross, Aetna, and Humana are some of the best in the under-65 market, but there might be others that are OK. In Florida, that's about all I will sell........Then, read your policy, especially the EXCLUSIONS page. If it is short and sweet, you're probably dealing with one of thos companies. If it is long and details a bunch of things that you could need covered, you probably are dealing with the wrong company.

Its OK if the exclusions page says "Must be medically necessary". All the good ones have that, too. They are just letting you know they are not going to cover things like cosmetic surgery simply to improve appearance, or a implant job or something.....

After that, it should be pretty short and sweet.

Good luck!

Answer 4

with a deductible, this means you pay first dollar, so you must pay out or your pocket the 1,000 before your insurance kicks in.

A coinsurance is a percentage of cost you pay. So after you paid the deductible, now you have insurance but for anything that has coinsurance, you will pay your part, in this case 20%.

Anything that requires a copay simply means that no matter what the cost, you only pay the copay. For example, you get an exaime at the dr office and it requires a 20.00 copay. You will pay this even if the dr finds that you are health. If the dr finds a problem that requires a certain treatment and your insurance has a coinsurance, you will also pay the coinsurance for the procedure/treatment.

just remember it this way.....

deductible = first dollar

coinsurance = % you pay

copay = fixed amount that you pay

and always remember to ask the insurance company and check your policy for the Maximum-Out-Of-Pocket. This is very important because it tells you what your total risk is.