Health Insurance Question?

  • by nick
  • Jun 30,2018
  • 11 answers

Just got health insurance for my daughter, very confused by all of this and wanted to reach out for a better understanding. This is what her papers say about the plan: (attached picture)
So basically, I have to pay 100% of my doctor fee's until the deductible is met? Regardless if they accept my insurance or not?
If that's the case, if I pay them 250 a month is that going towards the deductible?? Or is that only money that they are pocketing and nothing more?


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Insurance Answers (11)

mbrcatz 7 days ago

Yes, with the exception of any preventative care, you pay 100% of everything until the deductible is met. The $250 a month you pay for premiums, does NOT go towards the deductible - that's your cost for having the insurance.

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David 14 last week

It's very simple. The premiums you pay have nothing to do with anything. They pay nothing until your deductible is met. You want a lower deductible? Prepare to pay much more in premiums.

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B last week

you have a very cheap type policy. it pays nothing while you pay the premiums, with you paying the deductible, if you have a huge (over $6500+) then it starts to pay. Frankly I hope you are paying very little for this policy because it doesn't pay out quick enough.

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Insurance Pickle.com last week

Premiums purchase you the coverage. You NEVER "pay a deductible." You pay providers and the amount that s covered counts towards your deductible. Never ask if the "doctor accepts your coverage." All doctors accept all coverage. It s just a matter of whether and how much of your insurance covers or reduces the bill. You always want to ask "if the providers participates in network with your plan and network."
I had someone earlier in June tell a client they "accepted their insurance." When I corrected the way they were asking the question, the answer was "no."
If you don t like how big the deductible is, you can pay a higher premium, lower the deductible and transfer more of the risk to the insurance company.

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Flower 2 weeks ago

Your monthly premiums do not go toward the deductible. That is in addition to meeting the deductible.

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A Hunch 2 weeks ago

The insurance pays nothing to the provider until you have met your deductible
If you use in-network doctors, the medical bills will be discounted based on the agreement between the doctor and the insurance. My bills are discounted about 65%. I recently had a $4000 procedure that was discounted to around $1500.
After you reach the deductible amount, depending on your insurance plan, you may continue to pay a portion of the bill (often 20% until you have met your annual out of pocket maximum.

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Amy 2 weeks ago

Yes. You pay 100% of your medical expenses until you have paid $6650. There should be an exception for preventative care, such as an annual physical. This is a requirement under Obamacare, as is capping your cost at 6650.
If you go to an in-network provider, the insurance pays any medical expense above that amount. But if you have an appointment (i.e. not emergency care) with a doctor outside your network, you pay 30%.
This does not include the premium you pay for the insurance.
This looks like what's called a "catastrophic" plan: it protects you against large medical bills in the event of a catastrophe, but doesn't end up paying for anything (except preventative care) if you are reasonably healthy.

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Happy Gramps 2 weeks ago

rather than trying to answer you and maybe being wrong, it's best for you to call an agent and ask them

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Steve D 2 weeks ago

You have what is called a high deductible health care plan. You will pay out of pocket until such time as your deductible is met. If you stay within your network, your deductible is $6,650 and after you have spent that amount, the insurance kicks in at the listed above. If you go out of network, your deductible basically doubles (so stay in network). And no, your premiums do not count towards your deductible.
These types of plans are usually sold to people who also have a Health Savings Account (many times funded by their employer to a certain extent). The HSA is used to take care of the day to day health care expenses and the high deductible plan is used to take care of catastrophic health care emergencies (heart attacks, broken bones, surgeries. etc.).

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Judy 2 weeks ago

Yes, you have it right. The insurance pays nothing until you have paid the deductible amount out of pocket that year. And your monthly premium doesn't count toward the deductible.

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StephenWeinstein 2 weeks ago

You pay nothing, 0%, until the preventative care.
You pay 100% of the doctor's fee for other care, until the deductible is met.
The $250 a month is not going toward the deductible, but it is also not money that they are pocketing. By law, at least 80% must be spent on medical care, although not necessarily for you. Most of it is used to pay hospital bills for whomever has the same type of insurance and needs to go to a hospital. Hospital bills regularly run over $10,000, sometime even over a million dollars, so they have to use the premiums for more than one person to be able to pay one person's bills. They also have to cover some overhead expenses, such as the wages of their own employees. Less than 20% is even potentially available for them to pocket.

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