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Can someone explain a high deductible medical plan to me?

My DH's insurance is changing and not for the good! We have an awesome affordable plan now. We have the best plan available and pay 135.00 a week. They are changing companies, and there best plan is 315 a week. Which I think is ridiculous! They offer 4 different types of high deductible plans, but I have no idea what they are.
DH and I rarely go to the Dr. I have thyroid issues, and fibromyalgia. I only see Endo 2x a year.

Do you have to pay the deductible before your insurance kicks in? How does it work?
Thanks for the help!

Answer Question

Asked by Haydensmom326 at 12:27 PM on Oct. 6, 2008 in Health

Level 1 (0 Credits)
Answers (18)
  • Deductible refers to how much you pay out of your own pocket before insurance picks up the tab. So, for example, if your deductible is $5000, and you go into the hospital and your bill is $10000, you have to pay $5000 and the insurance will pick up the rest. If your bill is less than or equal to the deductible, they pay nothing. High deductibles really aren't a good thing.

    Answer by tropicalmama at 12:29 PM on Oct. 6, 2008

  • Yes, in most cases, you will have to pay your medical bills until the deductible has been met. If you're going that seldom, it might be better to find out about keeping the insurance you are already on. Some programs will let you maintain the insurance individually. Otherwise, unless your medical bills are exceeding the deductible, you'll be paying for insurance you cannot use. Trust me, I know this from experience!

    Answer by jespeach at 12:30 PM on Oct. 6, 2008

  • Depends on what kind of high deductible plan it is. If it is a regular plan with a high deductible, you can still have office/ER copays, rx copays and the deductible only applies to things like hospitalizations and surgeries. If it is an HSA, these plans only kick in after you have satisfied your deductible, but usually regular health exams, paps physicalls ect. are covered at no cost to you. You really need to find out the benefits on the plan. I work at an insurance co. Just saying high deductible plan really doesn't mean anything. You need to get benefit details. All plans are different.

    Answer by Anonymous at 12:38 PM on Oct. 6, 2008

  • Your deductible has to be met (meaning you pay this amount) before any insurance kicks in. Note that this is on a yearly basis so every January 1 (or whenever your fiscal year is), you start over. Typically, the higher the deductible, the lower the monthly premiums, and vice versa. You'll need to work some numbers to see what your best option is. High deductibles can be beneficial when you're thinking worst case scenarios. If you were to incur a $100,000 medical bill, paying a higher deductible and letting insurance take care of the rest is a better option sometimes than an 80/20 plan since then you'd be responsble for $20,000 vs. $5,000 (or whatever your deductible is). Also, determine what your montly premiums plus your deductible would cost you on a yearly basis under each scenario to help determine what might make the most financial sense for your family. Good luck.

    Answer by FootballMom85 at 12:44 PM on Oct. 6, 2008

  • There are lots of different options with HDHP. We have one that is great for us. We do not have insurance through an employer. We insure all 6 of us for about $500/month. Deductible is $1500 pp, with a family max of $5000 - BUT we took the option for preventative $ first, so all well check ups (including mamogram) are covered 100%. My daughter just had to go to the Dr for strep, so we'll have to pay for that. We look at our insurance as only for major things - hospitalization, surgery, major illness, etc.. We have no pre-existing conditions and no one is on prescription medication.

    We can put $5800/year into our HSA that covers our out of pocket expenses, and that money is tax deductible and earns interest tax free. If we don't use it, it continues to grow and is always our money.


    Answer by mnrock at 12:49 PM on Oct. 6, 2008

  • We have a High Deductible plan as well through my DH employer. DH employer pays for the premiums on the plan. So $0.00 is taken out of my DH for health care premiums. We also have a HSA (Health Savings Account). We do have money taken out of my DH check to be placed into the HSA. WE control the amount of money that is taken out of DH paycheck. It can be $0 if we want or it can go to a max of yearly deposit of $5,000. Our yearly deductible is $5,000. So that means we have to pay $5,000 out of pocket (including prescriptions) before our insurance will pay. more next post.


    Answer by SAHMinIL at 1:00 PM on Oct. 6, 2008

  • continue However, because we have money going into an HSA we just pay or medical bills with the HSA. Whatever money is in the HSA rolls over for the next year, and every year we can add $5,000 more to it. When DH is 65 whatever money is in the HSA account can be turn into an IRA. (which can be used for retirement). Right now we only use $3,000 of our $5,000 every year. So every year we have $2,000 rolling over and building the amount of money in our HSA account.


    Answer by SAHMinIL at 1:01 PM on Oct. 6, 2008

  • Oh yeah and well check and dental exams are 100% covered every year for us too.... We don't pay for those....we just have to pay if we need a cavity filled, or we go in because we are sick...

    Answer by SAHMinIL at 1:02 PM on Oct. 6, 2008

  • You need to look over each different plan, depending on whether it's an office visit or labs or an ER visit, some will make you pay on the deductible first which means you will get stuck with the whole bill or some things for example, labs may pay a straight 80%. Sit down and compare them and you will be able to decide which one is best for your family.

    Answer by sammiesmom2000 at 1:18 PM on Oct. 6, 2008

  • It depends. The percentage you pay towards health expenses is called coinsurance. However, often plans will have (for example) an 80% benefit for inpatient and outpatient hospital services, but a $50 copay at the doctor's office. Typically if your office visits are covered with a copay, you do not have to meet the deductible first for those, only on hospital services. I worked for a large insurance company for nearly ten years... one of the things I did frequently was help people understand their plans. If you wish, PM me and I can help you understand your benefit plan and how to make a choice. If you could scan the benefits tables and description of deductible and out of pocket max etc for your plan choices, I can simplify it for you.

    Answer by figaro8895 at 1:46 PM on Oct. 6, 2008

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