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How do health insurance deductibles work?

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How do health insurance deductibles work?

Postby mat93 » Wed Dec 28, 2011 6:36 am

The plan I am looking at has a $1000 deductible. It says its a 70% PPO.
How exactly do deductibles work? I get the idea that you pay the first $1000, but does that apply to every doctor visit? I don't ever remember paying out of pocket for anything. I always just pay my copay and then that's it. The only doctor I see is an endocrinologist and he does the labwork at his own office. Will I have to pay the deductible just to see him? I seem to get mixed answers like the deductible is only for surgery. I'm so confused and don't want to sign up for something if I have to pay that much up front, it doesn't seem like it saves much money.
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How do health insurance deductibles work?

Postby emlyn » Wed Dec 28, 2011 6:45 am

For all health insurance:

The deductible is the amount you pay per year, not per visit. You pay 100% until you have paid a total of $1000. Once you have paid that much in a year, you only pay 30% for the rest of the year.

For some health insurance it applies to doctor's visits. For other health insurance, it does not.

There is no insurance where it is only for surgery. With all insurance, it is also for all hospital admissions, and most other things. Doctor visits are one of the few things for which there might not be a deductible. Surgery is never the only thing for which there is a deductible.
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How do health insurance deductibles work?

Postby faerwald » Wed Dec 28, 2011 6:48 am

Yes, you pay the first $1,000 of every doctor visit. Some plans, exclude a "checkup" from that, and will cover one checkup a year. If you're seeing an endocrinologist to check, for example, your A1C because you're a diabetic, that doesn't qualify as a "checkup".

But the REAL truth is, depending on what your preexisting condition is, it's very likely that you'll flat out be declined - and you won't be ABLE to buy a health insurance policy that covers this preexisting condition.
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How do health insurance deductibles work?

Postby carlin44 » Wed Dec 28, 2011 6:56 am

Lets say your first bill is $500
With a $1,000 deductible you will have to pay that $500 out of your own pocket.
You pay bills out of pocket until you have paid the $1,000

Once you have reached that deductible, you pay 30% of your doctor's bills as a co-pay only.
It does save money IF you don't go to the doctors much. Run the numbers
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