I have Some Dumb Healthcare Questions

benbeecham

New Member
3
While I guess they aren't so much "dumb" as they are noob questions. Ones I'm sure may seem simple, but I I've just never been pressed to ask until now (and I'm almost 40). But with my healthcare changing soon, I really need to ensure I know what I'm doing when looking for new plans. So here goes...
  1. When I find a plan that has a deductible (ranging anywhere from $500-$3,000), I know you have to pay that in monthly before you finally can use the insurance. But does the deductible ever get used up? Like if I pay a $500 deductible, and then use $2,000 in insurance, does that mean I have to start again?
  2. Similar question to above; once the deductible is paid in, I assume it never resets or expires (unless used)?
  3. Most plans list an out-of-pocket expense in the amounts of $10,000, $12,000, etc. They state this is the most I can expect to pay over the course of a year for our family. Is it common to have this much expense associated with a plan you're already paying $400-$500 a month for?
  4. Another similar question to the above. Assuming you have to use it. If people are getting sick or if there is a small accident (like tends to happen with kids), how much is common to expect to pay out of pocket? Is it an extra $2,000 year? Maybe just a few hundred dollars? I'm clueless on that part.
 
Deductibles are usually annual. One you meet it you have met it for the year. It resets on Jan 1st each year.
 
While I guess they aren't so much "dumb" as they are noob questions. Ones I'm sure may seem simple, but I I've just never been pressed to ask until now (and I'm almost 40). But with my healthcare changing soon, I really need to ensure I know what I'm doing when looking for new plans. So here goes...
  1. When I find a plan that has a deductible (ranging anywhere from $500-$3,000), I know you have to pay that in monthly before you finally can use the insurance. But does the deductible ever get used up? Like if I pay a $500 deductible, and then use $2,000 in insurance, does that mean I have to start again?
  2. Similar question to above; once the deductible is paid in, I assume it never resets or expires (unless used)?
  3. Most plans list an out-of-pocket expense in the amounts of $10,000, $12,000, etc. They state this is the most I can expect to pay over the course of a year for our family. Is it common to have this much expense associated with a plan you're already paying $400-$500 a month for?
  4. Another similar question to the above. Assuming you have to use it. If people are getting sick or if there is a small accident (like tends to happen with kids), how much is common to expect to pay out of pocket? Is it an extra $2,000 year? Maybe just a few hundred dollars? I'm clueless on that part.



1) Not sure if you were using deductible and premium interchangeably but for instance if you have a $500 premium and a $2000 deductible the premium isn't included in the deductible.
2) Once the deductible is hit is is done just for the year then resets next year.
3) That's the max out of pocket. So if you have a $2000 deductible, you pay full price until that's hit. Afterward you pay your co-pay percentage for each service. That's listed on the summary of benefits. If you hit the $12000 MOOP your are no longer subject to the co-pays the plan usually picks up the entire balance.
4) That depends on the plan you have. Not sure if this is marketplace or not but usually if its just a doctors visit and in network it can range from 25-200 depending on the plan and it depends how bad the accident is.

It may be worth looking into the virtual visits because they can save quite a bit of money and for basic illnesses they can diagnose and send prescriptions over the phone/computer
 
Great info, just a few more quick questions...

  1. I see the programs from companies like Molina, Amber, Core and others have small monthly payments of $200 but large deductibles of anywhere from $10,000-$15,000. Obviously you'd never reach that paying your premium every month. So they expect you to pay more to hit that? Because that is almost $900-$1,000 month just to hit that every year. Seems like a contradiction.
  2. If I were to get a job where they have "good" health insurance, how much can I expect to save vs just paying for it myself? I know that's impossible to get specifics, just looking for a general ballpark.
 
Great info, just a few more quick questions...

  1. I see the programs from companies like Molina, Amber, Core and others have small monthly payments of $200 but large deductibles of anywhere from $10,000-$15,000. Obviously you'd never reach that paying your premium every month. So they expect you to pay more to hit that? Because that is almost $900-$1,000 month just to hit that every year. Seems like a contradiction.
  2. If I were to get a job where they have "good" health insurance, how much can I expect to save vs just paying for it myself? I know that's impossible to get specifics, just looking for a general ballpark.


You’re still confusing a monthly premium and a deductible. Monthly premium does not factor into your DED.
You’re paying your monthly premium every month no matter what. Let’s say in month 3 you get hospitalized and you have a $10k DED. You will owe that full $10k first before your coverage starts to pay.
 
Great info, just a few more quick questions...

  1. I see the programs from companies like Molina, Amber, Core and others have small monthly payments of $200 but large deductibles of anywhere from $10,000-$15,000. Obviously you'd never reach that paying your premium every month. So they expect you to pay more to hit that? Because that is almost $900-$1,000 month just to hit that every year. Seems like a contradiction.
  2. If I were to get a job where they have "good" health insurance, how much can I expect to save vs just paying for it myself? I know that's impossible to get specifics, just looking for a general ballpark.
Group Insurance is little bit different. It just depends on the group that's being insured if it's an older group in general it may be a little bit more than if you were to get it by yourself if you're fairly younger. As far as the high-deductible plans those are for if you're just planning to use it just for preventive services and you need a stop loss when going to the hospital. If you have more serious health concerns those plans may not be the best options.
 
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