Quick Health Insurance Question

[val2525]

IF it says "50% coinsurance after deductible", does that mean I pay half forever and ever? Or does the insurance company kick in at 100% once I reach the full deductible/out of pocket maximum?

I was thinking that my max out of pocket (single coverage) was $6000 (or $6500, didn't it go up this year?) and that's also the deductible on this plan.

I'm waiting for the enrollment folks to call me back. The fed site decided I didn't use the right security question answers.

[zoesam]

Typically it would say something like 50% coinsurance up to your OOP/coinsurance maximum, which is typically around $5K when I last looked at a policy like that (many years ago), so I would think it still means that the ins co kicks in at whatever your covered percentage is (100 or 80 is most common) once you reach the OOP/coinsurance max.

Like I said though, it's been years since I looked at that type of policy, so it could have changed.

[Deleted]

50% means you pay 1/2 of the contracted rate after you meet your deductible. So lets say you've met the deductible and you go for an x-ray and it costs $500. The insurance company negotiates a lower rate (called the contracted rate) for the service with the provider. If they negotiate the cost down from $500 to $200 then the insurance pays $100 and you pay $100.
Co=contracted rate

[val2525]

Interesting. I thought the deductible was your max out of pocket expense under the 'approved' plans. Guess I was wrong. I'm still waiting for them to call so I can enroll. Lines were full last night and the system said if you had a callback, it would count as being within the enrollment deadline. We'll see.

[Deleted]

Feb 16, 2015 17:57:25 GMT val2525 said:

Interesting. I thought the deductible was your max out of pocket expense under the 'approved' plans. Guess I was wrong. I'm still waiting for them to call so I can enroll. Lines were full last night and the system said if you had a callback, it would count as being within the enrollment deadline. We'll see.

There should also be a max out of pocket but your deductible is not it.  I have come to the conclusion that health insurance is only good for 2 things.  One is the negotiated rate.  If you don't have health insurance you would be obligated to pay the $500 for an x-ray, not the $200 the insurance negotiated.  It would be up to you to try to negotiate a cash payment with the provider and many times they will not negotiate.  The other is for a catastrophe.  A protection since you should have a max out of pocket.  
Without a catastrophe you will probably never meet your deductible. 

[Deleted]

Feb 16, 2015 18:35:43 GMT @toomany said:

Feb 16, 2015 17:57:25 GMT val2525 said:

Interesting. I thought the deductible was your max out of pocket expense under the 'approved' plans. Guess I was wrong. I'm still waiting for them to call so I can enroll. Lines were full last night and the system said if you had a callback, it would count as being within the enrollment deadline. We'll see.

There should also be a max out of pocket but your deductible is not it.  I have come to the conclusion that health insurance is only good for 2 things.  One is the negotiated rate.  If you don't have health insurance you would be obligated to pay the $500 for an x-ray, not the $200 the insurance negotiated.  It would be up to you to try to negotiate a cash payment with the provider and many times they will not negotiate.  The other is for a catastrophe.  A protection since you should have a max out of pocket.  
Without a catastrophe you will probably never meet your deductible. 

toomany, I totally agree, the contract price is so much an important part of insurance these days.  

[val2525]

Okey dokey. Got answers. It is 50% covered by insurance after deductible met, until I hit out of pocket limit. Since I'm single, the max out of pocket is $6500. I can live with that. Besides, the plan I picked gives you the first 3 doctor visits free Thanks all!