What does deductible mean when you try to get health insurance?

Question

it says plan type : PPO. Deductible. 2,500. Coinsurance 20%. Office Visit. $30. Monthly Premium. $60..what does all that mean??

Answer 1

It means you have a $2,500 out of pocket expense to meet first before insurance kicks in. Are you sure about that dollar amount? That is WAY high for a deductible. Perhaps that amount is really your annual out of pocket max?

Coinsurance 20% means that you pay 20% of the bill and your insurance pays 80%. So if the bill is $100, you pay $20 of it and they pick up $80.

Monthly premium is what you pay per month.

Again, check that deductible amount....that is outrageous.

Answer 2

PPO - Preferred Physician Organization = you choose your doctor (but he/she must be member of the PPO), Often, non-member Drs are allowed but what they pay is less.
Deductible amount is the amount you have to pay every year BEFORE the insurance company pays anything.
Coinsurance 20% = amount of each charge you have to pay. (Charge will be the PPO amount which is lower than what you would pay for same thing without insurance)
Office visit $30 - I don't know what this means. It could mean you have to pay $30 (and they pay the rest) or it could mean they will only pay $30 (and you pay the rest) for each and every office visit.
Monthly premium $60 you pay $60 per month and $720 per year plus the $2500 deductible = $3220... How sick do you expect to be?
The only qualifier is that some things are often not subject to the deductible - like hospital care or emergency care BUT this is totally up to the Insurance Company: That is they can sweeten a policy or make it really a lousy deal with the deductible and the exclusions. If they don't spell it out for you clearly (IN WRITING!) then they aren't someone you want to do business with, are they?

Answer 3

Deductible:
The amout ($2,500) you MUST pay toward a claim before your insurance company begins to pay.

For example, if your have a $10,000 claim and your policy has a 2,500 deductible, you need to pay $2,500 and your insurance company will pay $7,500.

Co-insurance:
In another words, Cost Sharing Principle. It means a certain percentage of the medical bill (e.g. 20%) has to be borne by you. The rest is taking care by the insurance company.

Office visit, $30:
The $30 is the Co-payment ( which is a Fixed Amount, $30 in your case) that you need to pay for a Office Visit service, the insurance company will pay the rest. Beware of types Office Visit services available for claim.

Monthly Premium:
The amount of money you need to pay every month ( $60, in your case ) to get the coverage.

***Find out the Maximum Out-of-Pocket Annual Limit for that plan too. The Maximum Out-of-Pocket Annual Limit inclusive of deductible and co-insurance.**

Answer 4

* Deductilble Means the money out of you pocket for the treatment
* Coinsurance 20% means the portion you have to pay after the deductible has meet the requirement.
* Visit - Co-payment - means that you have to pay the doctor's office everytime you visit the Doctor.

It is a very simplified description. However you should get the details from your agent. If your agent doesn't provide answer for your questions, you should change the agent.

In case you need a licensed agent who can answer all your questions regarding health, check this;

http://www.insureme.com/landing.aspx?Refby=614787&Type=health

I got may answer from the agent from this.

Answer 5

Deducutibes are generally only applied to out of network services. It sounds like you have a 100/80 plan desigin which means everything in network is covered by copay and out of network is covered by your deductible followed by the 80/20 coinsurance. The only exception is if your plan does not have a prescription card. If that is the case then, your prescriptions would be subject to the deductible. Their are many different plan designs so its hard to say when your dedutible would apply.