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 What is the best way to compare Medicare private plans available to me? |
in terms of premiums, coverage, deductibles, etc. thanks
Additional Details
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Lynda M ♥ | Maximum out of pocket expense PPO~ annual or per "incident?"? |
I have tried calling my insurance company and can either never get through or they may me feel ignorant. I have a 90/10 policy with $1000 maximum out of pocket. I have BCBS PPO and am just wondering if the maximum out of pocket refers to each incident or a calendar year. I am scheduled for a hip replacement with 4 days of hospital stay. Please note: I will contact my insurance agent I'm just wanting an experienced answer. Thanks! |
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nurse ratchet
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It is per calendar year. However, that $1000 amount may or may not include your deductible that you pay first. After the deductible, the company pays 90% and you pay 10% until you reach the out of pocket maximum. After that, there is no more expense to you regarding deductible and coinsurance for the rest of the calendar year. |
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Insurance Biz CT
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Maximum out-of-pocket is an annual amount, and usually calendar year.
First, you would normally have a deductible, the a co-insurance - in your case, 90/10. The maximum out of pocket of $1000 would include the deductible and the coinsurance max.
This could apply to all medical services or just to hospital services, either inpatient or both in and outpatient. Definitely check with your agent to ensure that you understand fully what is included in the deductible and your max out-of-pocket. |
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lckychrms515
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The maximum out of pocket expense is per calender year. That is how much you have to pay out of pocket after you have met your deductible before the insurance pays 100%. Say you have a $500 deductible. You have to pay the $500, after that, you start paying 10% of things until you reach the $1000 limit. After that, the insurance company covers 100%. I have a PPO with the same set up. Just be careful that you do not go out of network...most of that is billed at a higher rate to you (mine is 60%/40%, and the out of pocket is $7500!) |
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Still reading
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Usually, the maximum refers to an annual (calendar year) maximum, including all of your costs, including deductible, but not including co-pays. |
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Rick
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The Max OOP is per calendar year.
Keep in mind, if your plan has co-pays for office visits and/or Rx drugs. Even though you may hit your maximum out of pocket for hospitalizations, diagnostics etc - you will still be responsibe for your applicable co-pays.
99.9% of the time your co-pays are not subject to your deductibe and do not go toward your Max OOP. |
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DuSteDShaDoW
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The OOP is Calendar year. |
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mbrcatz
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it's per calendar year, NOT per incident. |
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