Choosing A New Health Plan

Jordan2 · ‎03-16-2010

I could really use some advice and have some questions, please don't turn this into a political thread. I remember there was someone named Terri (?) last year who knows a lot about the plans and offered help. I know what a deductible is and how you must meet it before the insurance kicks in. I know about maximum out of pocket expenses, the most you would have to pay out. I don't understand the correlation between the two. You can have a deductible of $1,000 and out of pocket expenses of $3000, I don't get it. Also what kind of expenses get applied to the deductible (not co-pays for doctors or drugs)? Also what does it mean to pay 10% coinsurance after deductible? I would appreciate any help anyone can offer because this is stressing me out!

MyGirlsMom · ‎03-09-2010

Q: Also what kind of expenses get applied to the deductible (not co-pays for doctors or drugs)?

A: medical tests. i.e. CAT scans, x rays, etc.

Keep Your Face To The Sunshine and You Will Not See The Shadow

beckyb1012 · ‎03-09-2010

@Jordan2 wrote:
I could really use some advice and have some questions, please don't turn this into a political thread. I remember there was someone named Terri (?) last year who knows a lot about the plans and offered help. I know what a deductible is and how you must meet it before the insurance kicks in. I know about maximum out of pocket expenses, the most you would have to pay out. I don't understand the correlation between the two. You can have a deductible of $1,000 and out of pocket expenses of $3000, I don't get it. Also what kind of expenses get applied to the deductible (not co-pays for doctors or drugs)? Also what does it mean to pay 10% coinsurance after deductible? I would appreciate any help anyone can offer because this is stressing me out!

Do a shout out for Terrier3. She is the expert. Good Luck, mine is going up by almost $100.00 for just me in my own private little world. I hate all this.

"Live frugally, but love extravagantly."

Jordan2 · ‎03-16-2010

@beckyb1012 wrote:
@Jordan2 wrote:
I could really use some advice and have some questions, please don't turn this into a political thread. I remember there was someone named Terri (?) last year who knows a lot about the plans and offered help. I know what a deductible is and how you must meet it before the insurance kicks in. I know about maximum out of pocket expenses, the most you would have to pay out. I don't understand the correlation between the two. You can have a deductible of $1,000 and out of pocket expenses of $3000, I don't get it. Also what kind of expenses get applied to the deductible (not co-pays for doctors or drugs)? Also what does it mean to pay 10% coinsurance after deductible? I would appreciate any help anyone can offer because this is stressing me out!
Do a shout out for Terrier3. She is the expert. Good Luck, mine is going up by almost $100.00 for just me in my own private little world. I hate all this.

@beckyb1012, thanks that's who I meant! Hopefully maybe she'll see this. I have to change my health insurance plan and find a new PCP!

LTT1 · ‎03-09-2010

@Jordan2 wrote:
I could really use some advice and have some questions, please don't turn this into a political thread. I remember there was someone named Terri (?) last year who knows a lot about the plans and offered help. I know what a deductible is and how you must meet it before the insurance kicks in. I know about maximum out of pocket expenses, the most you would have to pay out. I don't understand the correlation between the two. You can have a deductible of $1,000 and out of pocket expenses of $3000, I don't get it. Also what kind of expenses get applied to the deductible (not co-pays for doctors or drugs)? Also what does it mean to pay 10% coinsurance after deductible? I would appreciate any help anyone can offer because this is stressing me out!

@Jordan2

I will try as I have just had to choose a new 2017 plan.

Deductible: amount you must pay ($1000) before the insurance kicks In EXCEPT:

1) usually yearly checkups are free

2) Out-of-pocket-- once you have spent $3000 (ie: car accident) they will then pick up the expense. So, let's say car accident hospital bill costs $5000, you will owe $1000 + $2000 = $3000 from you. The rest of this bill they will pay for you.

Let's say a person needs monthly RXs totaling $50 /month. Each plan may offer differing methods concerning the RX falling under the covered deductible amount.

I will put a graphic from the plan I chose here as a demo.

My concerns (this is for MY NEEDS and yours may be different)

1) Can I go to an Emergency Care place and will it be covered? (My answer: yes they will cover this IF I go to an "in-network" place.

2) How much would I have to pay for if I would go to a hospital ER?

3) Is MY hospital "in-network?" (No not)

4) Are my favorite doctors "in-network?" (No not)

5),Which Doctor or Hospital will I see that are "in-network?"

HTH BRB

~Have a Kind Heart, Fierce Mind, Brave Spirit~

LTT1 · ‎03-09-2010

Image 21.jpg

@Jordan2

The above is an example only. This plan is no longer available.

$2000 deductible.(individual) check to see how this is handled if more than one person is on your policy.

Notice the counsurance/copay. You owe these amounts for these services.

Notice also that In the middle column you must use "in-network" to get the rates shown. Likely, if you go to an "out-of-network" doctor pharmacy or facility, you won't get any help from your plan. (What you spend then may apply to the total out-of-pocket total for the year, but I don't know for sure.)

~Have a Kind Heart, Fierce Mind, Brave Spirit~

Melania · ‎06-12-2013

@LTT1 wrote:
@Jordan2 wrote:
I could really use some advice and have some questions, please don't turn this into a political thread. I remember there was someone named Terri (?) last year who knows a lot about the plans and offered help. I know what a deductible is and how you must meet it before the insurance kicks in. I know about maximum out of pocket expenses, the most you would have to pay out. I don't understand the correlation between the two. You can have a deductible of $1,000 and out of pocket expenses of $3000, I don't get it. Also what kind of expenses get applied to the deductible (not co-pays for doctors or drugs)? Also what does it mean to pay 10% coinsurance after deductible? I would appreciate any help anyone can offer because this is stressing me out!
@Jordan2
I will try as I have just had to choose a new 2017 plan.
Deductible: amount you must pay ($1000) before the insurance kicks In EXCEPT:
1) usually yearly checkups are free
2) Out-of-pocket-- once you have spent $3000 (ie: car accident) they will then pick up the expense. So, let's say car accident hospital bill costs $5000, you will owe $1000 + $2000 = $3000 from you. The rest of this bill they will pay for you.

Let's say a person needs monthly RXs totaling $50 /month. Each plan may offer differing methods concerning the RX falling under the covered deductible amount.
I will put a graphic from the plan I chose here as a demo.

My concerns (this is for MY NEEDS and yours may be different)
1) Can I go to an Emergency Care place and will it be covered? (My answer: yes they will cover this IF I go to an "in-network" place.
2) How much would I have to pay for if I would go to a hospital ER?
3) Is MY hospital "in-network?" (No not)
4) Are my favorite doctors "in-network?" (No not)
5),Which Doctor or Hospital will I see that are "in-network?"

HTH BRB

Well said!! That breakdown is very important as it will leave out any surprises if an event should occur.

I just went through this too. We went onto the exchange and found a number of plans and then had our agent help us decipher the best plan for me. He is great.

But the crummy thing is that most of the carriers will no longer pay the insurance agency a fee so he can't help us anymore. It can be so frustrating and you think you are getting the right plan but not always.

Mom2Dogs · ‎03-09-2010

My health insurance will go UP $80.00 a WEEK! We were shocked and will have to dip into retirement money to keep the plan.

Going on the exchange was not available for me since I am offered insurance thru my husbands plan....even if I went on the exchange the price was only 100.00 a month less expensive for terrible coverage!

Also, if you get a subsidsy to help pay your insurance thru the exchange you are taxed on what 'they' 'give you'! What is the point of the 'help' if you are taxed on it at the end of the year?

Trying to figure out insurance should not be so difficult...