ComeCorrect
Expert
- 70
Correct me if I’m wrong (still a rookie) but I hear so much talk about the annual deductible amount and co-insurance percentage but isn’t what really matters is the annual out of pocket maximum?
Deductibles, Co-Insurance & OOP Maximum
- Thread starter ComeCorrect
- Start date
If you have a $10k claim on a $10k deductible, you're paying $10k. If you have a $10k claim on a $1k deductible with 20% coinsurance, you're only forking out $2800 ($1k + 20% of $9k). Yes, the annual OOP max is a big factor, but the lower deductibles/coinsurance limit the out of pocket expense so the prospect doesn't have to meet that annual max in the first place. Now if you were to have a $150k claim, you're going to hit that annual max either way, so then the annual max would be the important factor.
- 1,118
What really matters is that nobody really talks about the OOP maximum, everyone talks about the deductible and coinsurance like you said. So when you get a lead on the line who has already talked to a couple of other agents and you can show them what their true liability will be, you win extra trust over that first agent.
- Thread starter
- #4
ComeCorrect
Expert
- 70
My thoughts exactly!
It all depends who you are talking to. If the person can barely afford a $20 copay without having to skip a meal, the out of pocket max has no relevance to them (and why are you talking to them). They will be bankrupt long before they get there.
If you are talking to a healthy 26 year old male who goes to the doctor once a year, the out of pocket max isn't something he is going to relate to.
If you are talking to someone who sees the doctor on a regular basis, then they may understand oop.
If they ask about out of pocket up front, treat that as a warning sign that something needs to be on the application. They may have talked to someone else who emphasized it, or they may have had some pretty significant med bills previously.
Of course, out of pocket max is only good till you hit the lifetime cap, then it's back out of pocket again. Not something most people worry about, but some plans have pretty low lifetime caps.
Dan
If you are talking to a healthy 26 year old male who goes to the doctor once a year, the out of pocket max isn't something he is going to relate to.
If you are talking to someone who sees the doctor on a regular basis, then they may understand oop.
If they ask about out of pocket up front, treat that as a warning sign that something needs to be on the application. They may have talked to someone else who emphasized it, or they may have had some pretty significant med bills previously.
Of course, out of pocket max is only good till you hit the lifetime cap, then it's back out of pocket again. Not something most people worry about, but some plans have pretty low lifetime caps.
Dan
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