Monday, May 2, 2011

How do you meet a health insurance deductible?

Regarding Kaiser Permanente deductible plans: Does your monthly rate/premium count towards meeting the deductible? And then what about the Out-of-pocket-maximum. Where does this fit in?
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your monthly does NOT count towards the deductible. lets assume you select a Kaiser plan that has a $1500 deductible and a $2500 OOP (out of pocket max) with a 30% co-insurance. hopefully nothing like this ever happens to you but lets assume you are riding your bike and get hit by a car. you take a ride in the ambulance and spend the night in the hospital. you are going to get billed by the ambulance and the hospital. the total bills might be $20,000 if you didn't have insurance. but since you have insurance, Kaiser has already negotiated a deal with the ambulance company and the hospital to pay only $10,000 of that $20,000 bill. now because you have insurance you are only responsible for the $10,000 - rest is written off by the hospital. now of that $10,000 you will pay the 1st $1500, then you 30% of the rest which is $8500 until that 30% totals $2500. so 30% of $8500 is $2550. that means you pay the $2500 (OOP max) and the insurance company will pay 70% of the $8500 plus anything over $2500 you paid. now after that, you are 100% covered and will pay $0 for the rest of the year should have any more accidents. hope that makes sense. as you can see you are paying about $4000 instead of the $20,000 you would if you didn't have insurance. if you can't afford pay $4000 if something happens to you, then you might want to consider a plan with a lower deductible and lower OOP max. those plans with lower deductibles and lower OOPs will cost more per month. so you have to ask yourself, can you afford an extra $30 per month or afford to pay $5000 if you get hurt.? check out www.usdirecthealthinsurance.com for more info. compare dozens of plans and sort by deductible. let the agents help you decide and answer any questions you may have. they helped me and explained everything which i have just explained to you.
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