Author Topic: Health insurance: Deductible $0, good/bad? too good to be true?  (Read 35570 times)

kamas

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Health insurance: Deductible $0, good/bad? too good to be true?
« on: November 22, 2014, 11:03:11 AM »
I don't really know how this insurance thing works, they always seem to find a way to get your money.
According to this article, it seems that a LOW deductible plan is best, because you will always pay the full deductible before insurance pays anything.
"So, now, many plans on the Exchange (every one I have seen, but then I haven't seen every single one) are built around a deductible (in addition to other cost-sharing features).

Here's how it works and here's why it's critical to understand it before you choose a plan.

In the simplest terms, whatever level of deductible that there is means you, the patient, will pay 100% of the bill for your care until the deductible is met."
http://www.dailykos.com/story/2013/10/08/1244896/-ACA-Understanding-the-details-Deducing-the-deductible-something-you-DO-need-to-think-about


SO, while looking for health insurance, I see some plans that have ZERO deductible. Does this mean, as long as I pay the premium, the insurance company will pay for %100 of everything?
Is this a good or bad thing?
I am not sure what to think of it, they ALWAYS find ways to put many hidden fees and costs in there, so you end up paying more than ever.

« Last Edit: November 22, 2014, 11:06:38 AM by kamas »

TomTX

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Re: Health insurance: Deductible $0, good/bad? too good to be true?
« Reply #1 on: November 22, 2014, 02:58:50 PM »
Deductible is not the only way they get you. Copay,  coinsurance (ie you pay 25% of all bills) and out of network come to mind immediately.

La Bibliotecaria Feroz

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Re: Health insurance: Deductible $0, good/bad? too good to be true?
« Reply #2 on: November 23, 2014, 08:19:17 AM »
Right--even no deductible plans often charge, say, $30-$50 for a doctor visit if you're sick. With deductible plans, doctor visits are often not subject to the deductible, so instead of paying a hundred some dollars for the visit, you just pay $30-$50,even if you haven't met your deductible.

I have only once even come close to meeting my deductible, and that was when I went to the ER when I was pregnant. Most years, most people just don't get that sick. A sinus infection or case of strep throat isn't going to be that expensive. In general, we have saved money by choosing the highest deductible plan. Most reasonably healthy people will save money in the long run by choosing a higher deductible, but of course it's important to have just-in-case money set aside for that one year you break your leg or need surgery or whatever.

catccc

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Re: Health insurance: Deductible $0, good/bad? too good to be true?
« Reply #3 on: November 23, 2014, 10:07:49 AM »
I've always had $0 deductible plans when insured through my employer. 

Here's my understanding of selected health insurance terms:
Deductible- what you have to pay for services before any coverage kicks in
Copay- flat amount you pay out of pocket for certain services (dr. visit, specialist visit, rx, hospital stay)
coinsurance- the % you pay for services that don't have a specific copay after your deductible is reached
out of pocket maximum- the amount at which the coinsurance stops and coverage is 100%, probably subject to other conditions

I believe preventative care is always covered 100% due to new requirements.

kamas

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Re: Health insurance: Deductible $0, good/bad? too good to be true?
« Reply #4 on: November 23, 2014, 10:10:41 AM »
There are 5 insurance options here, basic info of what appears to be the most important factors, for all 5 options. It appears that , for example on kaiser2 listed below, it has a $0 deductible, and primary care doctor visit is fixed at $15. But, if you look at another plan with a high deductible, I would have to pay a percentage, such as 10%. So, in that case, it depends how HIGH the doctors visit cost is. Sometimes a very SIMPLE doctor visit would be $250, so 10% would be $25. Also, I think that FLAT RATE fees are easier to understand and deal with, since we KNOW for sure what to pay. If it is a percentage, then the final bill might be super high, and higher than flat rate fees on the other options. what do you think? See below:

option #1 Kaiser Permanente KP VA Silver 1750/25%/HSA/Dental/Ped Dental
Monthly premium
$81.66/mo.
was $620.66
Deductible
$1,000
group total
Out-of-pocket maximum
$4,500
Copayments / Coinsurance
   10% Coinsurance after deductible Primary doctor
   10% Coinsurance after deductible Specialist doctor
   $5 Copay after deductibleGeneric drugs
Dental
Dental: Family and child
More information
    Plan brochure
    Summary of Benefits
    Provider directory
Costs for medical care
Collapse -
Primary care doctor visit   10% Coinsurance after deductible In-Network; Not Covered Out-of-Network
Specialist visit   10% Coinsurance after deductible In-Network; Not Covered Out-of-Network
X-rays and diagnostic imaging   10% Coinsurance after deductible In-Network; Not Covered Out-of-Network
Laboratory and outpatient professional services   10% Coinsurance after deductible In-Network; Not Covered Out-of-Network
..........................
.......................
option #2 Kaiser Permanente KP VA Silver 2500/30/Dental/Ped Dental
Monthly premium
$112.31/mo.
was $651.31
Deductible
$0
Out-of-pocket maximum
$4,500
Copayments / Coinsurance
   $15 Primary doctor
   $25 Specialist doctor
   $15 Generic drugs
Dental
Dental: Family and child
More information
    Plan brochure
    Summary of Benefits
    Provider directory
Costs for medical care
Collapse -
Primary care doctor visit   $15 In-Network; Not Covered Out-of-Network
Specialist visit   $25 In-Network; Not Covered Out-of-Network
X-rays and diagnostic imaging   $15 In-Network; Not Covered Out-of-Network
Laboratory and outpatient professional services   $15 In-Network; Not Covered Out-of-Network
..................
...............
OPTION #3 Kaiser Permanente KP VA Silver 1500/30/Dental/Ped Dental
Monthly premium
$138.78/mo.
was $677.78
Deductible
$0
Out-of-pocket maximum
$4,500
Copayments / Coinsurance
   $15 Primary doctor
   $25 Specialist doctor
   $15 Generic drugs
Dental
Dental: Family and child
More information
    Plan brochure
    Summary of Benefits
    Provider directory
Costs for medical care
Collapse -
Primary care doctor visit   $15 In-Network; Not Covered Out-of-Network
Specialist visit   $25 In-Network; Not Covered Out-of-Network
X-rays and diagnostic imaging   $15 In-Network; Not Covered Out-of-Network
Laboratory and outpatient professional services   $15 In-Network; Not Covered Out-of-Network
.............
..............
OPTION#4 Innovation Health Insurance CompanyInnovation Health Aetna-INOVA Silver $10 Copay
Monthly premium
$101.94/mo.
was $640.94
Deductible
$2,000
group total
Out-of-pocket maximum
$4,400
Copayments / Coinsurance
   $5 Primary doctor
   $40 Specialist doctor
   $5 Generic drugs
Dental
Dental: No Coverage
More information
    Plan brochure
    Summary of Benefits
    Provider directory
Costs for medical care
Collapse -
Primary care doctor visit   $5 In-Network; 50% Coinsurance after deductible Out-of-Network; Limits and Exclusions Apply

Specialist visit   $40 In-Network; 50% Coinsurance after deductible Out-of-Network
X-rays and diagnostic imaging   No Charge After Deductible In-Network; 50% Coinsurance after deductible Out-of-Network
Laboratory and outpatient professional services   No Charge After Deductible In-Network; 50% Coinsurance after deductible Out-of-Network
...................
.................
OPTION #5Innovation Health Insurance CompanyInnovation Health Aetna-INOVA Silver $5 Copay 2750
Monthly premium
$149.21/mo.
was $688.21
Deductible
$2,000
group total
Out-of-pocket maximum
$3,700
Copayments / Coinsurance
   $5 Primary doctor
   $40 Specialist doctor
   $5 Generic drugs
Dental
Dental: No Coverage
More information
    Plan brochure
    Summary of Benefits
    Provider directory
Costs for medical care
Collapse -
Primary care doctor visit   $5 In-Network; 50% Coinsurance after deductible Out-of-Network; Limits and Exclusions Apply

Specialist visit   $40 In-Network; 50% Coinsurance after deductible Out-of-Network
X-rays and diagnostic imaging   No Charge After Deductible In-Network; 50% Coinsurance after deductible Out-of-Network
Laboratory and outpatient professional services   No Charge After Deductible In-Network; 50% Coinsurance after deductible Out-of-Network
.................................
.................................



Here are more details about the above 5 options:
kaiser1
http://pastebin.com/AJykvgkw

kaiser2
http://pastebin.com/pytmsGcR

kaiser3
http://pastebin.com/EWXsq87h

innovation1
http://pastebin.com/TcRPUxT9

innovation2
http://pastebin.com/FvpSbWRV

Gin1984

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Re: Health insurance: Deductible $0, good/bad? too good to be true?
« Reply #5 on: November 23, 2014, 10:35:17 AM »
Right--even no deductible plans often charge, say, $30-$50 for a doctor visit if you're sick. With deductible plans, doctor visits are often not subject to the deductible, so instead of paying a hundred some dollars for the visit, you just pay $30-$50,even if you haven't met your deductible.

I have only once even come close to meeting my deductible, and that was when I went to the ER when I was pregnant. Most years, most people just don't get that sick. A sinus infection or case of strep throat isn't going to be that expensive. In general, we have saved money by choosing the highest deductible plan. Most reasonably healthy people will save money in the long run by choosing a higher deductible, but of course it's important to have just-in-case money set aside for that one year you break your leg or need surgery or whatever.
I have not seen those.  I assume they are there but all the deductible plans I have seen don't do that.

Tyler

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Re: Health insurance: Deductible $0, good/bad? too good to be true?
« Reply #6 on: November 23, 2014, 11:19:48 AM »
I notice that the listed options indicate that the OP is receiving a sizable subsidy on the Silver plans.  That means they are also eligible for cost sharing, which is why the deductibles are so low (run the same search with $100k income and the deductibles and OoP expenses will be much higher).  Avoid coinsurance when possible, and you should get a really good deal.