Q: What is your plan deductible?
A: The amount of money the insured must pay for the below expenses prior to the insurance carrier beginning to cost share, usually paying 80% of future expenses.
- Diagnostic Testing and Lab Work performed at a physicians office that is not related to preventative care, copay does not cover these expenses
- Prescription Drugs if you do not have copay option
- Outpatient Procedures
- Inpatient Procedures
- Hospitalization
- Emergency Room; carriers may provide a richer benefit
- X-rays
- Therapy; some carriers impose waiting periods
Now...the most important thing you must understand is the value of your deductible. For example, if a $2,500 deductible is selected, do not assume that you are paying out the first $2,500 before the insurance carrier begins to cost share. The #1 benefit you receive by having a plan of coverage is access to the carriers network of providers. When services are rendered in-network, the insured should be responsible to pay anywhere between 30-70% off of retail cost. This final responsibility is known as the contracted rate. An outpatient procedure could cost $1,500/retail, with the final insured's responsibility between $350-$500. The final responsibility is what is applied against the plan deductible.
When you look at choosing a plan, please keep in mind that having covered services applying towards the deductible is a good thing, as you begin to chip away at your total financial liability if faced with a large claim.
For further questions on benefits please contact The Shoppe.
Thanks,
Jordan
