What's the difference between deductible and out-of-pocket expenses?

  • by rmj
  • Jan 08,2018
  • 7 answers

I have health insurance with United Healthcare. This plan in red, specifically: http://image.ibb.co/n8B3SG/My_Plan.jpg
What the difference between the $2,000 deductible and $3,000 out-of-pocket expenses? Do I have to pay both before they'll pay or what? I may eventually need major leg surgery on either one or both legs.


LIKE OR DISLIKE:

  

Insurance Answers (7)

Flower 5 months ago

Your deductible is the least you must spend before the insurance pays their portion. The out of pocket means the most you have to spend on medical services.

Help others find the most helpful reviews
Was this review helpful to you?  

Insurance Pickle.com 5 months ago

For that plan, you need to have spent $2000 on covered expenses (including the full, discounted cost for primary care visits) before you get to a point where you start to pay copays for services. Once you're paying copays for services and have spent a total of $3000 (which likely includes the deductible), you won't pay anything for covered services for the balance of the plan year.

Help others find the most helpful reviews
Was this review helpful to you?  

lucy 5 months ago

The $2,000 deductible is what you pay for (all) medical treatment (until) the medical bills are $2,001 or more. Once you pay out (more) than $2,000 then (most) insurance companies will pay 80% of the bill and you pay the balance of 20%.
Then the $3,000 max is when the (total) paid out by you, then once it reaches $3,001, then insurance pays 100% and you pay (zero).
So since this is the beginning of the year, most likely starting with (no) medical treatment (yet). And you may need surgery on 1 or both legs which will be expensive.
So say the surgery costs $10,000, then you will be paying $3,000, since will be hit with the $2,000 deductible and the balance of the out of pocket, thus insurance will be paying out $7,000 for a total of $10,000.

Help others find the most helpful reviews
Was this review helpful to you?  

Billy 5 months ago

A deductible is what you have to pay before the insurance will pay anything. Out-of-pocket expenses include your deductible, if any, but also include any copay you might have.
For example:
Say I've got a $100 annual deductible, but after that, my insurance covers 90%, and I go to the doctor and the doctor's visit is $350. My deductible is $100, my insurance pays $215, and I pay a $35 copay, so my out-of-pocket expenses are $135, the amount of my deductible plus my copay.

Help others find the most helpful reviews
Was this review helpful to you?  

Andy L. 5 months ago

You probably are not going to like this, but the entire medical system in the USA is broken and needs major changes. The $2000 is the money you pay for medical services and supplies BEFORE United Healthcare pays anything at all. After $2000 in medical expenses submitted that you pay, their deductibles kick in for each service. Then, the $3000 is the maximum amount of money that you pay per year for covered medical services and supplies in total. Major surgery in the United States is many thousands of dollars. Your maximum annual total cost is $3000 plus the $109.50 per pay period.
https://www.healthcare.gov/glossary/out-...
For information only to better understand USA costs, you can look at medical trips, where people travel to 'Thailand or other countries to get high quality surgery.

Help others find the most helpful reviews
Was this review helpful to you?  

babyboomer1001 5 months ago

A deductible is your annual user premium. You owe that before the insurance company will pay any benefits but, you do not owe it right off the bat, for example on Jan. 1. You only have to pay it at the time of your first medical appt., perhaps also on your second. Out-of-pocket expenses are things like bandaids, gauze, crutches - medical equipment/accessories/necessities that are not covered by insurance thus, that money comes out of your pocket.

Help others find the most helpful reviews
Was this review helpful to you?  

StephenWeinstein 5 months ago

Deductible is the amount you pay before they pay anything.
Out-of-pocket is the most that you may have to pay for things covered by insurance.
If the cost of the medical care is less than the deductible (for example, $1500), then you pay what it costs and they pay nothing.
If it's more than the deductible (for example, $4000), then they pay something, and you also pay something. What you pay varies, but it isn't less than the deductible and it isn't more for the out-of-pocket.

Help others find the most helpful reviews
Was this review helpful to you?  

Post a Answer

Your comment was successfully posted!

Or use your account on Blog

Error message here!

Hide Error message here!

Forgot your password?

Or register your new account on Blog

Error message here!

Error message here!

Hide Error message here!

Lost your password? Please enter your email address. You will receive a link to create a new password.

Error message here!

Back to log-in

Close