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Great explanation. What I have always found confusing is insurance coverage for my semi-annual trips to my general practitioner. I usually only make a typical $40 “copay” while at the same I rarely meet my annual “deductible”. Payment against my “deductible” kicks in when I have an “event” like your ski accident or the burst appendix I had 8 years ago. So if I get this right, after I have shelled over enough money to reach my “deductible” then my insurance starts to cover a portion (not all) of my continuing costs until I hit my “out-of-pocket maximum”. The “portion” of my post-deductible costs that insurance covers is determined by the terms of my policy. Is that more-or-less correct?
Hi Joseph - Yes, you've understood the "deductible" and "out pocket maximum"! And also yes, it does depend on the terms of the health insurance policy, so you'll have to go through the fine print. Regarding your copay, that typically DOES NOT go towards your annual "deductible", but again FINE PRINT! Hope this was helpful.
It is interesting how many medical bills are incorrect. I had a screening exam and the pre-exam office visit was charged as an office visit when it should have been covered as a preventative visit - $133 saved.
Thank you so much! If for Americans this is a complex subject, can you imagine for a foreigner that has a public health system with no cost in his homeland? It's hard to understand all this terms and of course, why is so expensive?!?!?! Crazy!!
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
Well, depending on the type of insurance you have, annual checkups and preventive care might be free or significantly less (e.g you might just have to pay a copay) even if you don’t meet the deductible - at least that‘s something. I always suggest calling your insurer to see what’s covered exactly!
@@DiamondNestEgg okay I will be applying to get benefits for the first time it’s a bit confusing tho, I’m trying to read through the book but I feel that I got some comprehension of it but not all… and yes preventative is 100% free it’s the other info on charts that’s a little confusing.. I do have the little booklet available, is it okay that if I send that over to you and maybe I could get educated about for a clearer understanding if that’s okay. I will still communicate with my insurance afterwards.
If my deductible is $0 but my out of pocket maximum is $2700 (includes deductible) what does that mean? Do I have to pay $2700 before the insurance pays?
If your deductible is $0, the insurance company starts paying whatever their designated % is from the very beginning. Here's more info on out-of-pocket max: www.healthcare.gov/glossary/out-of-pocket-maximum-limit/
This video should provide additional info: Health Insurance Basics | PPO vs EPO vs HMO ru-vid.com/video/%D0%B2%D0%B8%D0%B4%D0%B5%D0%BE-t6ZXFuriH0E.html
