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Health Insurance Deductable? |
i was wondering how the deductable works. i have a 250 deductable plan does that means doesn't matter which doctor i visit, if the cost is under 250 everytime per visit, i pay that amount out of my pocket? or does it means accumlate through out the year, after i paid $250 for any visit i have to any doctor(s), after that i only pay my co-insurance? thanks! Deductibles are amounts that need to be met on a yearly basis before medical costs will be paid for by insurance. Usually, there is an additional "co-pay" for office visits that doesn't count towards your deductible. Deductible costs are x-rays, labwork, MRI, CT, some referrals to specialists. For example... You go to your family doc for back pain...have to pay them $20 (copay). They order an x-ray of your back that costs $50 towards your deductible...(250-50...200 left on your deductible). Your family doc thinks you need to see a spine specialist...$40 copay (at least with my plan, specialists are double my primary physician). The spine doc says you need an MRI that costs $800...but you will only pay $200 to satisfy your deductible...then your insurance company kicks in to pay the remaining amount after your co-insurance ($600 left...say you have an 80/20 plan which means insurance will pay 80% of the remaining $600...and you pay the remaining 20%, or $120. The MRI comes back saying you need surgery...the insurance company will now pay 80% of that surgery and you will be responsible for the remaining 20% until you fulfill your calendar year out of pocket maximum. Every January 1, your deductible goes back to a total of $250 and you start over again. Now, keep in mind that just about every policy, every group policy is different...some things are covered and some aren't. Refer to your coverage literature that came to you after you got your policy, or if it is an employee plan, talk to your HR person...they can give more details than anyone on Yahoo answers because they know more of what is going on. I've had 3 different United Healthcare plans with three different jobs...and all three were different policies...yup...different coverages. A $250 deductible plan is awesome tho...real good compared to what I've had in recent years!! Obviously every plan is different, but how I understand deductables is this: You need to pay out $250 first, before your plan will come into effect. So say your visits cost $100 each. The first two times you need to pay it, but the third time you pay $50 and your insurance will pick up the remaining $50 and all other visits afterwards. Mind you, you will most likely have to repay this deductable in the next fiscal year of your insurance (most don't go by calendar year but by a fiscal date chosen by the company). Hope that helps! is your plan a PPO? if so, your deductable is what you have to pay out of pocket to a doctor or specialist who does not take your insurance (considered an out of network doctor). after you have paid the $250 annual deductable, then your plan will cover either 70% or 80% or whatever your plan allows--remember, that's the 'usual and customary' fee. you will be responsible for the remainder that insurance didn't cover. that $250 is an annual fee and is accumulated over a calendar year. if you go to an in-network doctor, none of these fees apply as your insurance will cover it all except your co-pay. Its the first $250 of each year - after that you will probably have a copay (anywhere from 10-50 per visit) and a co-insurance amount (thats usually 90/10, 80/20, 70/30, that means if its a 90/10 out of every 100 you have to pay 10). With my plan you can go to whatever doctor you want and you have to pay a co-pay. The Deductible is usually used with labs, x-rays, hospital stays. You have to pay $250 dollars before your insurance will start covering the services. For instance, I recently broke my leg and met my deductible. Now my insurance pays 100% on my x-rays, hospital stay, labs, and physical therapy. You need to find out what the deductilbe applys to. |
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