Revisiting Deductibles, Coinsurance, and Max out of Pocket...And COPAYS
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- Опубликовано: 16 июн 2024
- I made a video about this topic several years ago, but still to this day, one of the most common misinterpreted parts of health insurance. How do the deductible, coinsurance, and max out of pocket realte; Any why do I feel deductible is nowhere near as important as max out of pocket.
I am a licensed insurance broker, and a district partner for my company Healthcare Solutions Team. I am here to help ensure people make the best decision for their health insurance in their state. I am licensed in the following states currently:
AL, AZ, FL, GA, IL, IN, KY, LA, MD, MI, MS, MT, NM, NC, OH, OK, PA, SC, TX, VA, WI
Feel free to call me at 708-566-6589 to discuss any health insuarnce options in your state!
Email me here: jdavern@myhst.com
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Explained like a boss, thank you 🙏
You made it so easy for me, thank u so much
My pleasure 😊
Thank you so much! this helped alot! Theres no one to ask for help with these kind of things and insurance is so stressful!
Glad it helped
Detail explanation ❤️
Yes, but what if it is something that is not covered? Like, can they say no to a serious procedure?
THANK YOU!
This is so helpful. Thank you!!!
thank you
This video is why I got blue cross blue shield blue essentials silver 14..$1010 max out the pocket
What about prescription coverage?
My agent find insurance with deductible but I don't have out of pocket 0$ what is mean I have 625 deductible and $ 0 out of pocket max is good coverage. This is my question. And also have another question why people buy that kind of insurance with dectuble and also max of pocket why people just don't just deductible instead of buying deductible and out of pocket both why. See I got insurance just deductible I don't have have out of pocket m wondering please reply
So if not all members met the individual but the family deductible is met does that mean coinsurance kicks in for everyone? Or just those who met individual and family is met?
Would I have to satisfy the deductible before I start paying the copay?
In consultation case if the plan say 50 deductible and 30% co insurance what does that mean
Thanks in advance
What are your thoughts on a Indemnity (HPG) Health Protector Guard
from United Health Care. I have knee problems and might require knee replacement.
Thanks
Hey Terry. I like the plan itself(though it is a fixed benefit plan and now real insurance) but it will likely not cover any pre existing conditions. You can email me and set up a time to talk if youd like. jdavern@myhst.com
shabbirhealth.blogspot.com/2022/08/how-to-move-towards-spiritual.html
What does non-network deductible $0 of $750 mean??
Once I pay the max out of pocket amount for my family insurance. Is every cent after that amount for the rest of that year paid 100% by the insurance company?
yes
hi thank you for this video.. can we have a sample video about.. cross accumulation, carry over and other terms please
So once you pay the deductible is it done for the year or is it every time you go to the hospital ??
Done for the year or whenever the term resets. Typically 12/31 unless you work for an employer that has an effective date mid year
I bet there are a lot of people that are needing to know this now after being hospitilized during the pandemic. I learned in 2019 after multiple hospital stays and looking at your video on this topic later on. Thanks for revisiting this topic!
Appreciate it Ray!
My goodness I love you 🙏😭😩
And I LOVE YOU
Could you give an example of how copay, deductibles, and co-insurance works when visiting a provider? Thank you.
It completely depends on your plan and what you are going to a provider for. I would need more info
Much better video with more steady camera man hand! thanks for explaining everything
You bet!
So when my policy says no deductible or copay for a service, then I would be billed nothing? I am on a public employee plan.
That is correct. Very rare.
🔥🔥🔥
Damn! I am so stupidi. I have to play it 3 or 4 time to get the gist. 😅😂
I appreciate this video, I just started my first job as an RN and will have to choose a plan and I feel lost
I believed the coinsurance of 30% would come from the $7500 allowed amount?
Should it be that way?
shabbirhealth.blogspot.com/2022/08/how-to-move-towards-spiritual.html
Quick Question. Wife had heart surgery, we paid $8500 which was her max out of the pocket for the year. But we are getting bills from the surgeon ($1700) and from the pacemaker people ($250). Why are we getting bills when we meet Max OOP? And how do we handle those bills?
You need to call insurance about that. They could be bills from prior to you meeting deductible. OR, they could be out of network. OR, insurance has made an error
@@healthcaremadesimple5367 turns out the hospital collected $8500 at time of surgery. which was our max out of pocket. They only applied $6800 to the surgery and put the rest as a credit. Who wants a credit at hospital!! So after some arguing they gave us a $1700 refund and we paid the surgeon which maxed out our of pocket for the year
@@DavidL78613 The American healthcare system billing is atrocious. I have a relative that was going through a serious health issue. He had a coinsurance and deductible to meet. Problem was that he saw many doctors and was in the ER and admitted in a short period of time. They all demanded his deductible and coinsurance. The first doctor he saw was the last to bill. It was like all the bills were tossed in a hat and drawn at random. He had paid max. Out of pocket, but everyone was still saying he owed coinsurance, and they were threatening to withhold treatment unless he coughed up the cash! It was a nightmare, all while battling a life threatening illness! The insurance company was of little help, basically telling him to pay everyone and they would sort it out later!! But he didn't have the cash to pay everyone. It was insane. He's very sick in a hospital bed arguing with bureaucrats on the phone while the hospital is saying they are going to stop treatment! He was threatening lawsuits left and right and finally got it squared away, but no one should go through that!
My plan has individual out of pocket maximum as 5000 and family out of pocket maximum 10000. How it will work?
Coinsurance for visiting doctors is 20%. So it should be applicable till out of pocket maximum is met?
If you have 4 people in the household and the total of all 4 people meet $10,000 deductible, the entire family has then met their deductible.
Thank you so much for texting me back and answering my question! Very helpful! 😊
Any time!
@@healthcaremadesimple5367 can I have your contact, i need help! 😢
I’m looking at BCBS plan right now and I’m lost because for my family it is $900 per month that is for the wife and 2 kids and myself thing is we are very rarely sick and never use it but then I hear from friends who have (Obama) care and they say they pay like $150 for same size family so am I just retardant or can someone clue me in if the ACA plan is worthless
The people that are paying less must have much lower income than you Rocky and therefore qualify for subsidy
So essentially you want a low deductible and a low OOP correct?
That would be ideal
If someone meets their out of pocket max do the pt owes a copay?
Noe once the max OOP is met you should not pay for anything else the rest of the year
Does any money spent out of pocket on doctor visits or health care accumulate towards the deductible?
I’m still confused
Question! :)
Let’s say my deductible is $0 and my OOP max is $5000. And let’s say I’ve only met $1000 of my OOP max. Then, I have a hospital bill of $20,000. Am I only responsible for the $4000 left to meet my OOP max or am I responsible for the full $20,000 bill because at the time of the hospital visit I had not yet met my OOP max. I would appreciate your answer to my question so much! Thank you!!
You can never pay more in a given year than your plan max out of pocket. So in this case you would only owe the $4000 that is left.
Question. Does coinsurance kick in once I meet the deductible? Or does it only activate afterwards on the next time I use Insurance?
And you said knowledgeable insurance agents can help eliminate some OOP expenses. Can you get into more detail? Talk to insurance agent? Talk to hospital? Thank you.
Is COPAY count toward Deductible or Max out of pocket?
US Healthcare costs are horrible. Just disgusting. What is the biggest reason why there is no more competition between hospitals/doctors? Doctor's associations limiting doctor education? Or hospitals/doctors/insurance companies cannot compete federally? Can you explain?
Well for one: Inflation. Right now costs for ALL tests/procedure/surgeries are widly expensive and getting more expensive as we speak. To offset that, insurance companies need to raise their rates.
@@healthcaremadesimple5367why do I have to pay out of pockets when I am paying fee every month
So I have 750 Duductible and 2250 OOP. However, on my plan, it says ER visit will be $100 Copay (wave if admitted) and 10% of the charges after the deductible (For both In and Out of network). Which means doesn't matter if in or out of Network provider, I will only pay 10% after I've meet my dudctible. So in the case of 6000 bill (including Ambulance). How much would I pay? Also, is this a good insurance? I only pay $43 a month and it says my employer pays $383 a month.
How do you invest skoop?
Okay Martin, so generally speaking, investing calls for more knowledge. For this reason, it's crucial to have a strong support system (financial counselor) to lead you through, particularly while choosing assets. I work with Regina Louise Collaro, a registered wealth management company's partner investment advisor. For the record, it has been the best experience for my finances. You may have heard of her because of how well-known her services are.
She helped me become financially solid through investment, and now I profit from her passive income strategies on a monthly basis.Therefore, I'll suggest that you choose a reliable investment advisor for yourself.
@@skoopqueenI value your recommendations. It's challenging to locate a trustworthy person. I could really use your investment advisor after seeing how much money you've made through investing. If you don't mind revealing her information, that is
By looking for her name online, you can quickly uncover her information. She recently appeared on CNN and she is really simple to deal with no matter where you're located
You are correct, and I am only one of many who gained from working with Regina Louise Collaro. I had no reason to live when I lost my job due to COVID in 2020, and it will always be a memorable year in my life. Regina made it possible for me to live comfortably through passive income, thus I owe her my life. To be completely honest, I think she is an angel who was sent to help those who are struggling financially.
Hello. I am currently in the Medical Billing part of my online Medical Coding Course. Learning who pays first when multiple agencies invilved. Trying to understand why all don't charge the same and pay the same...
I have a question! I'm deciding between health insurance plans now and the plans I'm looking at say "100% coinsurance". Does that mean that they pay 100% after the deductible? Or does that mean I do? One plan says $4k deductible, $4k max OOP, and 100% coinsurance, while the other plan says $2k deductible, $4k max OOP, and 100% coinsurance... Does that mean that the first option is actually best because the 100% coinsurance means I'm 100% responsible until I meet the max OOP???
Hey Heather, If 100% coinsurance meant YOU had to pay that would be quite awful haha. 100% coinsurance means the insurance company pays all medical bills after deductible.
So 0% coinsurance means I have to pay everything until I pay my entire deductible??? It is so confusing
Can you pay your deductible or maximum prior to any medical expense? If so which would be better to pay off? Suppose you know you'll have a bunch of medical expenses throughout the year, which would be the best option?
You cannot pay off your deductible early
Your system is just broken. No other words to discribe that. 😢
How is it possible to meet out of pocket max but not deductible? I've met my max but still owe $76.69 deductible. Now for a procedure I'm told I have to pay the $76.69
Its not possible. If you have met your plans max out of pocket everything will be covered 100%.
Thank you from Algeria 🇩🇿 I want to consult you on some matters related to insurance companies.. We in this country have a bad insurance system. There is no private health insurance company.. I am in the process of opening a start-up company in this field and I want to understand the system well
If insurance denies a procedure/code, does it count toward out of pocket max?
Do routine exams i.e yearly physical, mammograms come under copay where they are covered 100% but you pay a copay for the visit. What about sick visit that’s not hospitalization just antibiotic’s RX. That always confused me with PPO plans.
As far as I understand, the first "serious" medical visit is the one that hurts the most (in terms of money) and then once you reach your oop you are fully cover?
Personally, I feel that as we age spending time in the hospital and under doctor care at some point is inevitable. I would rather pay a little more up front, predictable expenses, than have to worry about coming up with unpredictable amounts for deductibles and copays (that might repeat themselves as the calendar clicks over to a new year) when I am sick. The last question you want to have to ask your doctor when you are sick is, "How much is that going to cost?" I've been there. That shouldn't be the deciding factor in your care.
I need help. For the past 5 years my husband and I have been on a HDHP plan with HSA(employer gives a monthly contribution of $50) we pay $156/month (deductible of 3,000/fam and 9,000/fam for out of pocket). Within these 5 years my husband had a kidney transplant and has medication that he’ll be on for life as well as regular Dr visits and specialist visits. Lately we’ve been thinking about having a child and whether or not we should switch to an PPO. The PPO would cost us $216 per month (2,400 deductible/fam and 12,400 out of pocket/fam)
Can you help me decide or what should I be focusing on. I’m so lost and scared of change but the PPO would be about$35 for copay at Dr so it sounds like it might be better bu
I had a baby in April. Girlfriend and I are not married, but both have the same insurance (BCBS) working for the same company. Deductible single is $2600, family is $5600. OOP single is $2600, family OOP $5600. I asked the hospital to put the baby under my insurance at the time of birth, hospital did not do that, so it went to the mothers. (Reason was she was going to be stay at home mom) Tried to resend it back through my insurance and insurance denied it again. My girlfriend already had medical complications and needed to get them checked out before birth after she had to go to the ER 6 months into pregnancy. So she had already paid close to around $2000 all in all out of pocket before birth. Birth comes and we are billed $16,000 and insurance only picked $7500. We are STILL fighting with BCBS and the hospital about the out out of pocket and deductible. I am exhausted and have no idea what to do about it. Because $1300 has already been sent to collections
Idiot insurance agent haha....self depcration is always funny.
Hey im in illinois and I have this crazy question on the exam which asks ' A guy is in a police chase, gets injured, meanwhile the two cops die in a crash during the chase, guy gets convicted on manslaughter, what will the insurance MOST likely do w regard to his ADnD'? Cancel his plan amd refund premiums? Or just simply keep his policy in force while obviously not pay the benefit? Surely no benefit as he was injured while commiting a crime.
Any Videos on "Coordination of Benefits" when you have 2 Family plans? My question: How does it work if the Husband & Wife work 2 different jobs but BOTH have the SAME EXACT BC/BS PPO Blue Family plan. Husband just got a job which offers the exact same plan ! My husbands plan will be "Secondary" due to my Birthdate being earlier - his has a LOWER Deducible ($1,500 Ind/ $3,000 Family)...(Mine is $2,500 Ind/ $5,000 Family).. Will having his Secondary Insurance help save us $$ throughout the year if there is a surprise Surgery or large medical bill / will it help pay my higher Deductible ?? Trying to decide if he should pay the extra $300 a month or Opt out. I can't find this particular situation , the pros & cons anywhere on the net. Thank you - appreciate your channel !