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Additional Details
I really really appreciate the kindness of sharing me your time in answering this!... |
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Janiesgotagun | Health insurance for dummies?? (that dummy would be me)? |
Ok I'm leaving my parents coverage in a few months and am scouting health insurance companies....thing is...I have no clue what they are talking about!!! The thing I am most confused about is the deductible...if a plan has a $1000 deductible does that mean for a normal doctors visit I first have to pay $1000? (ok please dont laugh at me, I have no clue) Or do I just pay a copay (it says $30 copay for doc visits) If I do just pay a copay then what is the $1000 for?? is that for hospital visits? Lol, I dont have $1000 bucks to go to the gyno! ;-) Somebody help me, I am going out of my mind! |
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Thomas T
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To be sure you'll need to read the policy carefully. Generally the $1000 deductible is what you pay before the insurance kicks in. After that you'' need to make co-payments according to a percentage set by the insurance company. The "per-visit" $30 payment may or may not be a true "copay". That's why you need to examine the policy. It's a good idea to do the math before you commit. If your premium is $600 per month and you have a $2000 deductible for example, you'll need to shell out $9,200 each year before the insurance company pays a dime. Then you start your co-pay. Then, depending on your claim, they will deny coverage for being "experimental" or unnecessary or excluded due to a pre-existing condition even you didn't know about. If you have too many claims they'll cancel your coverage. If your coverage lapses, they'll find a reason to refuse further coverage by claiming you're too fat, or too thin, or had an unreported yeast infection 12 years ago. Europeans and Canadians do not have these problems. They also have much better health care systems than the US since you don't need to fret about deductibles and copays. Good luck! |
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JaredBalis
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It can be confusing at first. Think of your deductible as your stake in your healthcare. The company wants you to pay the first $1,000 of your expenses each year. For that, your monthly cost will be lower than it would if you didn't have a stake in your healthcare.
So whenever you go to the hospital, in for surgery, to have major medical tests done, like MRI's and CATSCAN's you will be responsible for the first $1,000 of the bills. Then your benefits will kick in and your insurance company will start paying.
Most insurance companies will pay 80% of the rest of the bill. Some pay 100%, some 90%, some 70%, some less. You are responsible for the remaining %. However, you do have a stop loss typically, or a maximum amount you would pay if your portion hit a certain dollar amount. A common stop loss (or out of pocket maximum) in Utah is $3,000. So once your deducitible and your percentage (may bne 20%) reach $3,000 for the year, the plan typically covers you at 100% until the lifetime maximum (in Utah most are $2,000,000).
Office visits and prescriptions may be your responsibility, but most of the time your health plan will pay for office visits and prescriptions. All they ask is that you pay your co-pay, or a set dollar amount for each visit or prescription. It can work both ways. The way to figure it out is to ask your insurance company if the deductible is waived for office visits and prescriptions. If they are, you will most likely just have to pay a copay for those things.
A great way to get help with this is to connect with a local health insurance agent in your area. You can do that by filling out the form at http://www.myinsurancequotes.net. It doesn't cost you a thing and there is no obligation. What it does do is connect you with a local person who does this for a living and can really look out for your best interest. Good luck!
Jared Balis
http://www.utahinsurance.org |
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Butterfly Lover
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OK Health Ins 101
There are different types of plans:
HMO: You pay a copay only, but you must see a network provider and sometimes need a prior authorization to see a specialist even if they are in the network
Indemnity: you have a deductible and coinsurance. A typical plan might have a $1000 deductible and 20% coinsurance. This means you pay the first $1000 for your healthcare per year. This is not aid all at once, but you pay for doctors visits, tests, drugs, etc. until you spend $1000. Then they will pay 80% of what they consider usual and customary charges for the rest of the year. So, assuming you have met your deductible and need to see a doctor and he charges $200 for the visit, but the insurance company thinks $100 is the U&C, they will pay $80. You are then responsible for the $20 coinsurance and the $100 they disregard.
Then there is PPO. This works the same as the indemnity plan, except if you go to a network provider you are only responsible for the coinsurance after the deductible.
Some plans offer you both types. You pay a copay if you stay in network and if you go out of network it is one of the other scenarios.
If I haven't completely confused you, my suggestion is, if the HMO includes most of your doctors, or doctors you would be comfortable seeing go that route. |
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Zarnev
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You should visit a local independent agent. The agent can sit down with you and explain how the policy works and the coverage. The plans and premiums are exactly the same whether you use an agent or not.
To answer your question - It depends upon the plan. Some plans will have the co-pays subject to the deductible and some won't. The plans with the co-pay not subject to the deductible you just pay the $30 doctor visit co-pay. The deductible will come into play if you have to go into the hospital. After you pay the deductible you will then have to pay co-insurance with many plans. The agent can explain co-insurance as well. |
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Avani
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http://www.insuranceplan4u.com |
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mbrcatz
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Scout for coverage using a local agent, NOT THE INTERNET. It won't cost you any more, and the agent can help explain terms and compare coverages and prices for you.
If a plan has a $1,000 deductible, that means, starting January 1st (or whenever) it doesn't pay ANYTHING until AFTER you've paid the first $1,000 of COVERED bills. That's like, 6 - 8 doctor visits. Then, after you've hit the $1,000, you ALSO pay the copay EVERY VISIT.
If the first thing you have is a gyn visit, you'll be paying for it out of pocket. |
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tswann77
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Another option is discount health benefits. You don't have the high cost of the monthly Ins rates, co-pays or deductables. The monthy rate is very reasonable for anyone to have. Plus all on-going health problems are accepted. You can go here to find out more about it: www.everyonebenefits.com/trodgers |
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