I am a bot, and this action was performed automatically. The benefits are obvious. I would double check, because otherwise this doesn't make sense (like you said.). 1. A small explanation first: I'm Native American, if you don't know why that's relevant it's because I receive health care, insurance free, through treaty rights as long as I use the Indian Health Service. Have a $3,000 out-of-pocket bill from a hospital stay, the plan pays $3,000. Are you sure that's really the case? good advice stranger! I apologize, and have since corrected my explanation. The amount the insurance company pays after you meet the deductible will depend on your coinsurance percentage.Let’s say you purchase a health plan with a $3,000 deductible and 20% coinsurance. Thank you. Have 2 sibs in medicine and this is 100% true.. and it bothers me when it comes up with them. Generally speaking, the point of having health insurance is to use it when you’re sick or need to see the doctor. Deductible Vs Out-Of-Pocket. It depends on your company and your coverage. I've been paying cash out of pocket for all doctor visits and medication, and it has been cheaper than paying for insurance. After that, the bills sent to the auto insurance company were sent to me. Ergo, what really makes health insurance cost a lot is when people get very sick it costs a lot of money to treat them. This annual out-of-pocket amount includes: Premiums; Anything you pay that the health plan doesn’t cover; Out-of-network care and services; Out-of-pocket maxes vary by plan. Even with health coverage, you’ll still have out-of-pocket costs. Once you've spent 13000 out of your pocket for the year, you will no longer pay for stuff. Insurance claim vs. paying out of pocket. Here's a counterpoint. Yup. Is there any reason I shouldn't just pay out-of-pocket for health care? In the event of an emergency the facility treated me is considered referred care from the IHS. I have no idea where to start with that process. For health insurance, deductibles are per year, not per event. Cookies help us deliver our Services. That is incorrect on so many levels. Health insurance, for many of us, will lose us money. That’s it. Co-pay plans will still have a deductible (in some cases it will be $0) and out-of-pocket maximum. I've been seen recently by the local hospital once a month for 4 month and was charged $600. For a stupid broken finger.   High-risk insurance can be very expensive. Since you need to pay out of pocket for that amount anyways, if the cost of the damage to your car is close to, or … Imagine how much car insurance would cost if it had to pay not only for car wrecks, but also pay for oil changes and tire rotations. There are also some restrictions - for example, you can only have double coverage with standard HMO/PPO plans (you can’t have two High Deductible (HDHP) Plans). Please contact the moderators of this subreddit if you have any questions or concerns. Our moderation team encourages respectful discussion. I am not gambling on emergencies, because emergencies are not going to cost me anything in the event they occur. What about those awful things that happen to some of us some times? Deductible is usually for a single medical incident. Welcome to r/personalfinance! It had a $13,500 deductible, 2 primary care visits each for a $60 co-pay, and a physical included for each of us. I am a bot, and this action was performed automatically. Considering my special circumstances; why? Not all costs count towards your out-of-pocket maximum, but most cost-sharing expenses do. Insurance will cover a portion of your costs and you will pay the rest, which is called coinsurance. Cookies help us deliver our Services. Co-pays usually do not count towards the deductible, but they do count towards your annual out-of-pocket maximum. This has been the case for most of my life until I moved too far away from the IHS to make it worth while to make trips for check ups/routine appointments. Most people who don’t purchase health insurance figure they’ll just pay out-of-pocket if something small, but still unexpected, happens. Aetna has an excellent reputation and is one of the largest … (other types of insurances can be how you describe- such as homeowners or car). We buy it for the insurance that if a big nasty thing happens, we won't be ruined. Basically, if you have the cash handy, you go to the billing office (or call) and start dickering. New comments cannot be posted and votes cannot be cast, More posts from the personalfinance community. If you got a real healthy savings, maybe you want to take the gamble. 100% could be for in-network only, or maybe GP visits only - do you have a co-insurance for out-of-network? Alternatively, if you have a large family, then they could aggregage another $6,500 in claims between all of them without any other individual paying all of their deductible to hit the $13,000 MOOP after which all claims would be covered at 100%. It ended up needing 2 pins to set it and of course another operation to remove the pins. The only time I do not get free health care is a routine checkup somewhere that is not the IHS. Sure, something could happen that would cause huge hospital bills, but at that point a type of catastrophic health insurance could kick in if that was a concern. As such the concerns of needing Health Insurance is new to me (I'm almost 30). if I am stable I am transferred to my primary health facility, if I am not stable and need to stay where I am the facility I am at is considered deferred treatment from my primary facility. I had already paid 100% of my out of pocket, and then in addition paid that $773. Bit of a barrier to even start with. You may find the Health Insurance wiki page helpful. My deductible is 6500, after which everything is 100% covered. One has a deductible of $2000 with an Out of pocket max at $8500 for $900/mo. This has also (and still does) protect me from fines associated with not having health insurance. Once you spend enough to reach your plan’s limit, the insurer will cover 100% of your medical bills. But what about the ones that can't? This whole case is only non-emergency, non serious check ups and maintenance. I have heard it's possible to negotiate prices with hospitals. Please contact the moderators of this subreddit if you have any questions or concerns. It would be more cost effective to pay for the pothole claim out of pocket vs. collect $600 to help with repairs. I have no idea where to start with that process. For family coverage, the cost for premiums in 2018 is $1,168 per month. An out-of-pocket maximum is a cap, or limit, on the amount of money you have to pay for covered health care services in a plan year. The insurance will only pay the $100 presuming you've met your out of network out of pocket max. Make sure everything is marked "paid in full" and you are good to go. emergencies get deferred to my primary care physician if I'm stable (IHS). You receive nothing more, but … What I'm noticing though is you didn't take into account my special circumstances. large things like operations, eyeglasses, and dental I simply travel home for. You do not receive credit for that $50 to your OON deductible or OON OOP and insurance will never base their payment off the $150, only the $100. or perhaps for specialists, hospitals, lab tests, or prescriptions? Anything like a surgery or a broken bone will be treated by my primary physician at the IHS. However, there are some occasions when it may actually make sense to pay for medical care out of pocket rather than use your health insurance coverage. The other has a deductible of $5800 and the same OUt of pocket max at $8500 for $769 Quick, precise, and to the point. You may find our Health Insurance wiki helpful. There’s a less expensive option but this sounds like the best since we have high medical costs. New comments cannot be posted and votes cannot be cast, More posts from the personalfinance community. In health insurance, your out-of-pocket expenses include deductibles, coinsurance, copays, and any services that are not covered by your health … Here are examples: A high-deductible plan can’t exceed more than $6,900 out-of-pocket for an individual and $13,800 for a … Is this a plan with an embedded deductible? What family deductibles and out of pocket maximums do is protect people who have multiple family members on their plans from paying outrageous amounts. If you meet that limit, your health plan will pay 100% of all covered health care costs for the rest of the plan year. Are you sure you don't have "coinsurance"? Learn about budgeting, saving, getting out of debt, credit, investing, and retirement planning. In my state's Individual market 7% of the people account for 60% of the costs. Taking these things into consideration: I am not legally required to have health insurance, using health insurance for check ups is very cost ineffective, large things like operations, eyeglasses, and dental I simply travel home for anyway, and the cost of emergencies get deferred to my primary care facility (IHS). Of the bills I did see, it was well over $50k. you pay for all bills till you hit your 6500 deductible. Generally speaking, nurses and doctors don't know or care how much their services cost. A better ability to pay the reduced price if something like this to. Co-Pays usually do not count towards your out-of-pocket maximum, on the and! 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