Trying to understand health insurance...?

Question

I don' really understand all those terms about health insurance. I want to buy one, but money is very important. Let's say I buy insurance with 2000 deductible, 2000 out-of-pocket, $30 co-pay and 30% co-insurance. Then I visit doctor that charges $200 per visit. Then I have x-ray and blood test done that cost $500.

What do I pay altogether? Someone told me that it would be $530 (co-pay + test) coz I wouldn't have met deductible yet. Is that true?

Answer 1

What you ultimately pay, depends on what the contracted rate your doctor has with your carrier. They don't charge 100% of the cost to you or the carrier. They submit the bill to the carrier and the carrier takes their discount. That discounted amount is applied to your deductible. Then the doctor also writes off the discount and should bill you only for the balance. You would also owe the office co-pay amount of $30.

If the doctor charged $200 for an office visit, he would write off the $170 difference and bill you for $30 since that is his agreement with the insurance company.

Since we don't know what the discounted amount is between your doctor and insurance, we can't really say how much you would owe. But it would be much less than the $700 in actual charges.

Answer 2

That sounds right.

What you really need is a policy that will cover you if you have a major medical problem, such as car accident, that could easily run up $20,000 in medical bills.

With insurance, there's a trade-off: high deductible gives you a cheaper insurance rate, but you have to pay for a lot more small things.

The real problem with this policy is the 30% co-insurance.  That means it only pays 30% of the expenses beyond the $2,000 deductible.  That's almost non-existent insurance.  With this policy, that $20,000 car accident will cost you $13,900 cash out of pocket ($2,000 deducible, plus 70% of the remaining $18,000).

Answer 3

Not quite. For me, the co-pay is the amount my doctor charge me each time I visit me. So, in this case, it would be $30. As for the 30% co-insurance, it would be the amount that I will be responsible (30% x 500) = $150.  As for the deductible, it would be the maximum amount that I need to pay out of my pocket, which is $2000 / year. Each insurance company's health plan operate differently, please check with them direct to clarify.