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Honored Contributor
Posts: 9,102
Registered: ‎03-09-2010

Do you know if the deductible has to be paid in full beore beneifts kick in?

 

Esteemed Contributor
Posts: 6,288
Registered: ‎12-24-2010

Re: Insurance question: ACA

[ Edited ]

I assume so.........deductible gets applied to any bill(s) first......then the insurance coverage kicks in.

OR do you mean you still owe a balance to (doctor or such)....so deductible hasn't been satisfied yet?

 

Perhaps I read it incorrectly.

Esteemed Contributor
Posts: 6,645
Registered: ‎08-19-2014

Yes you have to satisfy your deductible first. Some plans allow you 1 or 2 doctor visits outside the deductible.But plans differ.

Esteemed Contributor
Posts: 5,779
Registered: ‎03-19-2010

The only benefit I am aware of besides the Mammogram and bi-annual Pap (which they still won't pay if it goes to the wrong lab or an out-of-network doctor reads your Mammo) is the discounted prescription benefits if you're lucky enough to be on a Tier 1 drug (aka generic).  Everything else is subject to the deductible plus your Co-pay.

 

I looked at my account late last year and I had "spent" all of around $5 against my $6700 deductible.  That's $975/month right down the drain.

Honored Contributor
Posts: 9,102
Registered: ‎03-09-2010

I posted before about a friends friend with insurance issues....what ever she has is paying for almost nothing.  She was told to apply for ACA, which I guess (not sure) will pay for an illness after you buy the insurance!  This person has cancer stage 4 with 6-12 months life span.

 

So I was wondering if they had to spend down all their deductible first before any bills were covered...I think @Icegoddess  answered the question...deductible paid in full first, correct?

 

 

Esteemed Contributor
Posts: 5,779
Registered: ‎03-19-2010

@momtodogs wrote:

I posted before about a friends friend with insurance issues....what ever she has is paying for almost nothing.  She was told to apply for ACA, which I guess (not sure) will pay for an illness after you buy the insurance!  This person has cancer stage 4 with 6-12 months life span.

 

So I was wondering if they had to spend down all their deductible first before any bills were covered...I think @Icegoddess  answered the question...deductible paid in full first, correct?

 

 


@momtodogs Yes.  The ACA is not a panacea except for people who are below the threshold so that they get their premium subsidised by the rest of us.  So, if she is lower income, she at least might get lower payments and a lower deductible.  They really aren't forthcoming with that info once you are on it.  Every year when I get my notice that the Premium is going up there is absolutley no mention of the Deductible even though it has always gone up too.  When she is shopping for it, that info should be available though.  I'm not sure that she can change insurances now though since open enrollment was only in Nov/Dec unless Biden opened it up again.  I do remember hearing some rumblings about that. 

 

I have friends who are on some infusions and now one who is starting cancer treatments (for the 3rd time) and whatever infusions they are on clear the deductible in one or two months.  I would imagine cancer treatments might be similar.  A couple of treatments and she might be over her Deductible.

Super Contributor
Posts: 292
Registered: ‎07-26-2017

I have an ACA plan that actually pays portions of bills before my full $8300 deductible is met.  I was actually surprised about this. It all depends on your plan.

Honored Contributor
Posts: 13,428
Registered: ‎10-25-2010

If you have a deductible, it must be met first before your claims are paid. Your insurance company will let you know how much you own on each service.

 

If a doctor charges $200 and $80 is allowed, $80 will apply to your deductible and if the doctors is in network, you will NOT owe the difference between the $80 allowed and $200 charge.  

 

You should never pay the doctor upfront..wait until you get your explanation of benefits  ( EOB) then you will know the correct amount to pay.  Some providers will bill you too much upfront and you will have to fight to get your money back.

 

Not all services apply to the deductible...for example, routine covered examinations  and tests...like Pap and mammogram and GYN exams.

 

Also, some services might have a copayment and no deductible. For example $25 copay for an office visit.  You should be prepared to pay the copayment at each visit.


Read your benefits or call the insurance company so you understand...no surprises that way.

Valued Contributor
Posts: 876
Registered: ‎01-05-2017

Call your insurance company. They are the only ones that can answer your questions.

Esteemed Contributor
Posts: 6,503
Registered: ‎03-09-2010

My employer plan cost me $700+ per month with very large deductibles. I was thrilled when I turned 65 and could get Medicare and a supplemental policy. It saved me $400+ per month, eliminated most copays, limits my deductible to $230 per year, and covers 100 times more than my employer plan ever did.