Can anyone explain to me how a high deductible insurance plan works?

I'm switching jobs and my new insurance will be United. My employer said its a high deductible plan.

Right now I have a PPO where I pay my $30 copay and then everything else goes to insurance to get worked out.

Under a high DD plan, let's say I go to the doctor for a checkup, am I paying the total bill right then and there? Or getting billed for it and I have to pay in a month or so? I feel like I just dont know if I can afford those expenses every time I go to the doctor. Can someone explain to me how a plan like this would work and if it's better or worse than a lower deductible plan?

Re: Can anyone explain to me how a high deductible insurance plan works?

Its your employer paying for it right?

If so, that is why they chose a high deductible, because its cheaper.

Ex: $1000 deductible

say Doc appt- $100. you would have to go 10X before the insurance would kick in and pay.

And all that would be out of pocket expense.

Re: Can anyone explain to me how a high deductible insurance plan works?

Re: Can anyone explain to me how a high deductible insurance plan works?

Posted by HomeIsWithU
So, I would pay that $100 doctor visit fee at the time of the visit? Or get billed for it?

That sort of s ucks. By the time I reach my deductible each year its going to be the next year and I'll have to pay all over again

Message edited 10/28/2011 4:18:03 PM.

Re: Can anyone explain to me how a high deductible insurance plan works?

Our deductible is $3,000. I go to the doctor, pay the co-pay and they bill me later for the rest of what the insurance does not cover. The only years I have reached the deductible is when I have had babies. This year my deductible and co-insurance is met so everything for the rest of the year is 100% covered, im getting in everything I need done in the next 2 months!

Re: Can anyone explain to me how a high deductible insurance plan works?

If they are offering that they are probably also offering a HSA? Health Savings acct? This way you can have pre tax dollars taken out and put into the hsa and they give you a debit card to use for that deductible. You can also use it for certaon OTC meds(you can get a list through a google search)

Re: Can anyone explain to me how a high deductible insurance plan works?

DH's company (like a lot of companies) are switching to high deductible plans. It also has an HSA component, so DH's employer contributes quarterly half of his yearly deductlbe. I think ours is $3000 (so every quarter DH's company puts in $375.00 into that account). DH contributes $60 a pay cycle to this HSA. You get debit card/checks to use the funds in this account for medical related expenses.

That said, you pay for everything until you meet that deductible. Your dr. will apply the in-network discount that is contracted with said insurance company, and you will be billed for the difference.

Example:
I just went to my family dr. for bloodwork. The lab sent me $92.00 bill; and then I got a bill from the dr. himself for the 5 min visit to take my blood, another $92.00

I used the money in the HSA to cover those 2 bills.

I would probably not meet the deductible yearly unless i had some sort of surgery or had another kid. It seems like a plan for relatively healthy folks who dont have a lot of prexisting conditions.

so thats it in a nutshell.

I would find out if your company is contributing to the HSA part of the high deductible option.

Re: Can anyone explain to me how a high deductible insurance plan works?

We had one of those at my DH's old job. It was a 4k deductible. It worked where you pay the 4k out before insurance covers anything (our annual well visit and kids well visits were covered 100%) but anything else went to our deductible. You are usually entitled to an HSA account where you can have money deducted pre tax from your pay check or you can make contributions to the account and deduct taxes later (his job didn't set it up to deduct before he left so we never got to take advantage of it). Then you can pay your deductible from that account. Once you meet your deductible sometimes they pay 100% other plans you still have a copay so it depends on the plan. The advantage of the HSA was that the money DID roll over to the next year and you don't lose it like an FSA account.

Honestly it stinks depending on what you were/are paying monthly along with copays for your insurance. Depending on what your company charges you to have the insurance will depend on whether it is a good deal for you or not. We went from that to paying $800 a month with a low deductible and copays that weren't very cheap. So it really depends on where you are coming from.

Keep in mind if you only use it say 3 times a year for minor things you won't meet your 4k deductible but it will probably be cheaper than if you pay a lot out of your check monthly with copays. But you could be screwed if you end up in January in the hospital with a 5K bill b/c you will have to owe that 4k right upfront.

Re: Can anyone explain to me how a high deductible insurance plan works?

Forgot to add you pay the doctor the insurance companies "contacted rate" or the rate they would pay IF they paid the doctor directly - not necessarily what the doctor would bill..

Re: Can anyone explain to me how a high deductible insurance plan works?

Posted by HomeIsWithU

Posted by Smileyd17

Its your employer paying for it right?

If so, that is why they chose a high deductible, because its cheaper.

Ex: $1000 deductible

say Doc appt- $100. you would have to go 10X before the insurance would kick in and pay.

And all that would be out of pocket expense.

So, I would pay that $100 doctor visit fee at the time of the visit? Or get billed for it?

That sort of s ucks. By the time I reach my deductible each year its going to be the next year and I'll have to pay all over again

Re: Can anyone explain to me how a high deductible insurance plan works?

We have a plan with a $5,000 deductible. We've had it a few years so far. We have an HSA that has more than our annual deductible in it.
Luckily we have been very lucky with medical needs and it has saved us tons of money. Prior to this plan we were paying $1300 per month for insurance that we rarely used.

I personally think plans like this are the solution to getting more people insured.

Re: Can anyone explain to me how a high deductible insurance plan works?

The concept of this is pretty simple. Basically insurance is a risk game. The more coverage you are likely to receive the more you will pay for it.

Traditional HMO/PPO plans cover the "day to day" expenses of going the doctor and ask that you pay a small copay. A high deductible plan lets you pay the first $1000-$5000 out of pocket however the plan costs are cheaper.

Psychologically this seems worse since you are always paying for your health care. I am always amazed at how people are galled at the idea of spending money on health care yet have no problem forking over money to their mechanic.

However for some this works out cheaper in the long run (esp if you use pretax dollars in an HSA to pay for health care). It requires more discipline since you're not just paying out $10 copays when you see the doctor. It also allows you to be a consumer and "shop around" to find the best deal for your health care.

Re:

Message edited 6/2/2012 10:37:28 PM.

Re: Can anyone explain to me how a high deductible insurance plan works?

It's been explained well.

I just wanted to add that in our experience it's not as bad as it sounds.

DH's company offers both a regular HMO and the high deductible. Because the high deductible plan is so much cheaper per month, there is literally zero reason to go with the HMO regardless of how frequently you go to the doctor. It would make sense even if we never went!

I think companies are pushing people to the HD plans.

DH funds the HSA account with a few grand in January and February just in case any of us have a hospital stay early in the year.