Information About Health Insurance Deductibles

When purchasing health insurance plans, you can purchase plans that do not require that you first meet the deductible before receiving most routine medical treatment. Many of these services only require that you pay a co-pay, and most co-pays run between $10.00 and $75.00. You may pay higher co-pays for services at an emergency room or for ambulance rides. A co-pay pretty much tells you that you don't have to meet a deductible. If your policy doesn't have a co-pay for a particular service, then you are probably subject to your deductible and, in most cases, coinsurance as well. You will have to meet a deductible for most outpatient services such as lab, x-ray, radiology, inpatient or outpatient surgery, or hospitalization.

Answers to Your Health Insurance Deductible Questions

Example: Lets say you have a $100,000 hospital bill. You will have to pay your deductible. If your deductible is $5000, you will pay the first $5000 of that $100,000 hospital bill. That leaves a balance of $95,000. Next is cost sharing of that $95,000 balance. If your coinsurance benefit on your policy is 70/30, then you will be responsible for 30% of that balance and the insurance company will pick up 70%. If your 30% responsibility is not capped, you would owe 30% of $95,000 or $28,500. However, most policies have what is called a maximum out of pocket or coinsurance limit. If your coinsurance limit is $5000, then you are only responsible for that $5000, not the whole $28,500! The insurer will pick up the difference. Therefore, your true out of pocket maximum on your policy is the deductible PLUS your coinsurance limit. In this case, you would be responsible for $10,000 (your $5000 deductible plus the coinsurance limit of $5000). Therefore, you pay your 30% until you hit that cap.

It does not make as much difference as you may think when choosing between a 70/30 coinsurance plan versus an 80/20 coinsurance plan so long as you have a reasonable cap. Without a cap, the 80/20 plan would be considerably better. However, most policies do have a cap on coinsurance.

For more information on how to choose the right deductible amount and the right insurance plan for you, contact a Health Insurance Deductible Expert at Bottom Line Insurance today. Always refer to your insurance professional and specific carrier benefit information and policy information for benefit specifics.

Information About Health Insurance Deductibles | Answers to Your Health Insurance Deductible Questions

Bottom Line recommends that you talk to one of our consultants before applying on any website including ours.   When comparing benefits from each carrier, the benefits aren't always as they appear.  You are making an important decision.  Call for complete policy information before applying. 

There is no added cost when applying through Bottom Line or for consulting with our insurance professionals.  Premiums are the same as buying direct from the insurers and you get ongoing customer service year after year at no added expense to you.