If I have a 5000 deductible for health insurance, what is the point of getting it?

Question

I need to get insurance for a year while i take some time off of school so i need insurance. If there is a deductible, does that include office visits and prescriptions? Do I have to spend thousands or does that not apply for meds and dr visits?

Answer 1

I am not a insurance professional at all, I just have a policy like you with a high deductible. It does not include office visits or prescriptions. It is mainly for catastrophic illness or major accidents. If you had a serious car accident and the hospital bill was 80,000 (which would add up in like one week with surgeries), you only need to come up with 5,000. Not all things are covered with insurance too. I had an accident last July and had to pay over the deductible cause insurance just doesn't cover some things the doctors charge for. And, the higher your deductible the lower your monthly payment. Good Luck.

Answer 2

It all depends. With a $5000 deductible, you're probably paying next to nothing in premiums, right? BUT, that deductible could go towards any number of things:
1. ALL medical care
2. Labs, X-rays, and procedures
3. Cost-sharing - which means that the insurance has a prenegotiated rate with the provider and the insurance pays a portion, and you pay a portion, usually a few dollars per visit.
4. Hospital charges (ER and if you're admitted)
5. Out of network providers

You need to know specifically what your deductible is for BEFORE you purchase the insurance. This will avoid nasty surprises later. Also, if you take this plan - NEVER pay up front - let your insurance be billed FIRST. The insurance will put X amount towards your deductible, and tell the provider how much to bill you for. This is also to used to track when you meet your deductible.

The beauty of these kinds of plans is that if you don't use them, you're not spending a ton of money to have insurance. (Many HMO-type plans cost $400 a month or more for individual, high deductible plans are often less than $200 - the insurance gets this money whether or not you use the insurance.) This way, also, you're covered in case something really bad happens. You should also be eligible for a HSA - Health Savings Account - with a plan like this. It's where an amount of your pre-taxed money is put aside to cover ANYTHING medically related. Some even cover things like Tylenol.

Answer 3

The purpose of health insurance is to protect you financially from a huge loss in the event of a catastrophic event. It is NOT meant to be cheap health care, although that's what it's come to be associated with for most people.

To specifically answer your question, you're better off with a $5,000 deductible policy than without insurance, even though you may never reach your deductible in any given year because you do have the peace of mind of knowing that you wouldn't be completely financially devestated if you had to have a $600,000 open heart surgery, or any number of other things.

You would also be eligible for network discounts on the services you receive. And those discounts can be HUGE. For instance, in my own personal experience, I had bloodwork done once before I'd received my new health insurance card, so they originally billed me the full amount (of approximately $390); when I submitted a copy of my new health insurance card, they adjusted the bill -- to $72.

The uninsured end up paying MUCH higher prices for healthcare than anyone else. Unless they can afford to pay up front in cash. And you may still be able to do that (and wish to do that) for your basic doctor visits.

But very few people could, or would, pay up front for a surgical procedure. So, hospitals, surgeons, etc. bill approximately 10 times what they actually expect to get paid for their services to the uninsured, then they plan to (and usually end up) selling the account to a collection agency for 10 cents on the dollar 90-180 days later.

The collection agencies take over then. And it gets uglier from there. The fastest way to go bankrupt in America is to be without health insurance.

The type of plan you choose will determine whether or not the $5,000 is applicable to doctor visits and prescriptions. Most plans that are not designated as High Deductible Health Plans (HDHP -- meaning they are compatible with Health Savings Accounts) do provide copays for doctor visits and prescription drugs. But it's all in the details. Ask lots of questions and don't sign anything until you understand it.

Answer 4

You can find out more information about what exactly is considered when meeting a deductible. Usually, office visits and prescriptions are Not but instead will require a co-pay amount. Example: Office Visit amount billed $180.00-Co-pay $15.00 that you would pay out of pocket. Just for comparisons, my husband had a hip replacement that was done 3 yrs. ago and at a cost of $173,000.00 was in the hospital only two days. I had a 3-hr out patient surgery last year, not hospitalized and it was over $7000.00. The costs are skyrocketing and can wipe out a person, their savings and future income as well, so it's still better to pay a portion than the whole amount, especially if it is critical to stay alive. Just for you own info-call a hospital and ask what one day stay will run (that will only be for room and meals), the other things like meds, bandages, blood work, x-rays, use of operating rooms, anesthesia, the surgeons and all the other specialists involved adds up too quick. Hope this will give you a better picture.

Answer 5

I worked with insurance for a while. Everyone is right, a policy like that is for major emerencies...surgery etc, but... Your insurance company has discounts worked out on contract with hospitals. Say you go to the ER for a broken bone and the bill without insurance would be 3,000 dollars. If you have insurance, even though you'd have to pay it all because you have a high deductible, you'd get the benefit of the contract and only have to pay, say 800 dollars for the whole ER visit thanks to your insuer's contractual discounts. Something to think about.

Answer 6

If you don't have any asset and not much money in the bank.
FORGET ABOUT HEALTH INSURANCE
When you get sick or hurt, the government will help.
This is not a thrid world country, hospitals will help.
$5000 deductible is just pointless for a student.
If you have asset over $50,000. Then consider getting insurance.
It's great to be either rich or poor, not in the middle.
I am in the middle, I have to pay for everything.
Another option is to move to Canada. LOL

For now, if you get sick, just ask the doc for a discount for paying in cash.

Answer 7

A comprehensive plan that covers dr visit copays and a drug plan won't cost much, probably low $100's for a young person. High deductibles are for people with the money to lay out for out patient services. You don't have the cash.

Get a full coverage plan.

Answer 8

It will depend on the plan being offered. Some are for hospital services, and others are for all medical services. Find a local agent and ask him/her to review your options with you. This will help you understand the coverage you are signing up for.

The point of having it is that there is a lower cost and should something serious happen to you, the insurance will pick up the major part of your expenses, like hospitalization.

Answer 9

The deductible includes EVERYTHING. So you have to spend $5,000 before anything gets covered.

The POINT of it is, if you fall and break your hand in such a way that you need surgery for your wrist, you don't have to pay $75,000 for it. Or if you have a heart attack or stroke, you don't have to pay the $250,000 for medical treatment. Or if you're tackled playing football and break both legs, you don't pay the $100,000 for inpatient traction for six weeks.

Or - assuming you're FEMALE from your id name - what if you get PREGNANT? Do you have ANY idea how much it costs for prenatal care and to give birth, IF everything goes well? If you get pregnant when you're NOT insured, it's going to be excluded when you pick up coverage again, as a "preexisting condition".

It's intended to cover MAJOR medical problems, which DO occasionally crop up, even with you youngsters.

Answer 10

remember when it was called Major Medical??? It looks like you might have that.

You might just have a monster deductible to keep your premium down. but you need to submit everything to your company, they will reject it, saying "applied to deductible" but they are keeping track of it.

And as for health care costs.. My Bro-In-law had to have his spleen removed last june.. he was pretty sick and had received several pints of blood before they figured out what was wrong. 21 days at Univ of San Francisco Med. Center including surgery = $253,000 and change.

that $5000 ded looks really good.