With health insurance what is a deductible?

Question

Ok i am about to get bluecross and blueshield But i am confused at this deductible.The insurance has a $15 co pay for doctor visits and all that stuff and $10 for drugs.One plan has a deductible of $2,500 and the other $250.It says per person and i want myself wife and son covered.What is better?We are healty people but my son is 2 months old but he is healthy.Is it better to have a small deduct or a high deduct?Please help with any info!

the co insurance for the 250 deduct is 4,000 for the family and thats the same with the 2,500 deduct.
and it says my total out of pocket expence includes my deduct,co payments,and coinsurance?I dont know what that means...

Answer 1

Okay, let me try to simplify this for you.

If you go to the doctor or specialist, then you will have to pay the fixed copayment amount for those visits ($15 as you cited in your example.)

However, if, for example, the doctor orders any kind of testing done while you're at this visit, that is NOT covered under the doctor visit copayment (and there are plenty of other examples of what would not be covered under the copayment amount.) So, in this example, the tests that are run are billed separately from the medical testing lab and let's say they run a total of $450 (and that's not all that unusual.)

If you have a $250 deductible, then you have to pay the first $250 of that. But even once you reach the deductible, you will also have to pay a co-insurance amount (usually 20 - 30%) until you reach the maximum out of pocket for the year.

This means that, in the example, you would pay the first $250 (if you had a $250 deductible) PLUS you would also have to pay the co-insurance amount above that ($450 - $250 = $200, so that would be an additional $40 if you have a 20%copayment amount.) So, if you have a $250 deductible and a 20% co-insurance, you would end up paying the first $290 of that initial $450 bill for labwork. However, if the same thing happened again in three months, because you had already met the $250 deductible, you would only have to pay the co-insurance amount (if that's 20%, then 20% of a second $450 bill for lab work would run you $90.)

If you had a $2,500 deductible, you'd have to pay the entire $450 both times, of course. But sometimes it's worth taking the higher deductible if you can save enough premium.

Another thing to consider: is well-baby care covered with a flat copayment, covered before the deductible, or would it be treated like everything else? It can be a big deal, because kids end up needing a lot of immunizations and preventative care.

Also, be certain you do know what counts toward your maximum out of pocket for the year, because most policies do NOT count the copayments you may for doctor/specialist visits and/or the prescription drug copays. (Which means that they don't count toward your annual out of pocket maximum, but also that these are expenses you would still have to continue to pay even if you met the maximum out of pocket for the year.)

Hope that helps! Feel free to email me if I've confused you even further...

(I was a diabetic who had to wade through all of this when I lost my corporate benefits after 9/11... I learned it so well and saw such a need for it to be explained well, I decided to become an insurance agent!)

Answer 2

OK, the MOST you pay out of pocket, excluding drugs, is $4,000 per year.

The lower the deductible, the higher the monthly cost.

If you have a $250 deductible per person, you pay the WHOLE $250 for any covered services, FOR EACH OF YOU, EVERY CALENDAR YEAR, before the insurance pays a penny. Even AFTER you pay the $250, you STILL have to pay your copays every visit.

Having a $2500 deductible per person, means, you WILL have to pay out $2500 before the insurance kicks in ANYTHING. So that's why that plan is cheaper.

At 2 months, you're going for VERY regular checkups & shots - one or two visits will hit your $250, so I'd go for that with a little baby, over the $2500 deductible. JMO, but you can run the numbers yourself with the premium difference, to see which makes sense.

Answer 3

Hello,

Deductible is an amount which the insurer should pay. I will explain you with an example. Let's say you buy health insurance which has a deductible of $250 USD. This means that when ever you spend an amount less than $250 USD you will pay it from your pocket. If your expense towards health problems exceeds above $250USD then only you can claim the money from the insurance industry.

Concept of deductible normally occurs in marine where a person takes an insurance policy with a high deductable because the insurere would need Insurance money only when the ship sinks in that case he will loose everythig otherwise he does not require any insurance money. By including deductible in the insurance the amount of insurance premium should be less.

Answer 4

Generally, you want to get away with the least amount out of pocket as possible. SO, check the following before you sign on the dotted line: What, EXACTLY, is the deductible for? Is it hospital, is it procedures (lab tests, x-rays, etc), is it out-of-network, is it cost-sharing? That makes a big difference! If it's hospital, labs, or out-of-network, it's not a big deal - if you don't use it, you don't pay on it. (and it would probably take a LONG time to reach the deductible if you do use it) If it's cost-sharing, meaning, you're paying the copay AND towards the deductible, it's a big deal, because you're going to be paying a LOT over the year - especially with a 2 month old. (We charge about $500 for the exam and vaccines for a child that young.)

Answer 5

The deductable is very simple, but you wouldn't know unless someone told you. What a deductable is is a payment that you would make if for instance you were to go into surgury. Kind of like car insurance, if you get into an accident and go to get the car fixed, you would pay the $500 deductable if that's what your plan entailed. Generally a higher deductable will mean that you're going to be paying less for the insurance plan and vice versa. So if you'd like to gamble and figure that everyone will be healthy then go for the plan with the higher deductable because you will be paying much less per year.

Answer 6

A deductable is an amount you meet before your insurance kicks in payment. Usually a higher deductable means you pay more out of pocket but your premiums are less...however, 250.00 is a good deductable then there may be a co-insurance which is 10%-20%-30% that you pay out of pocket and then insurance pays the rest.

Hope this helps.