Question about health insuranceFollow

I'm hoping some of you can simply explain how deductibles, copays, and the like work for me, because I'm sort of confused.

So, say I have a $200 deductible, a $5000 copay (I think?), and insurance covers 90%. From what I can tell, this means that I pay full price out of pocket for the first $200, then after that I pay 10% of costs until I've paid $5000, then insurance covers the rest from there? Or am I completely misunderstanding this?

edit: I'm not sure if copay is right, because I thought copay was a set amount you pay no matter what. However, I'm pretty sure that's what the person told me. I know that $5000 is the "out of pocket maximum" though.

Edited, Oct 5th 2011 11:37am by Vataro

Move to canada get real health insurance, and never look back.

You already paid for it with your taxes. Oh, sorry, wrong country.

Doesn't it say on your insurance card? Usually it has a list of things like emergency room, scheduled visit, etc..

Bottom line is that if you end up with an huge medical bill, you will pay at maximum $5200. Your insurance will pay the rest. And start actively looking for a legal loophole to drop you.

For the plans we have offered where I work, any co-pays and deductible count towards the maximum out of pocket.

On a side note, we have a $2000 maximum out of pocket ($4000 for a family plan, but $2000 per person) and people still complain about the plan. My step father has no maximum. Even only having to pay 20% of the total costs, his heart attack earlier this year cost them about $15000.

Yup. Unfortunately I won't get billed for a month or two, so hopefully there won't be any surprises then.

$2000 max out of pocket not being much is a pretty scary thought to me.
It's a max of €200 here (you can increase that to €500 I think, maybe even 1k if you want to pay less per month)

Not compared to the million bucks that leukemia treatment costs the insurance company. $2000-$4000 max is pretty reasonable.

Ours has $10 copay for preventative care and most medicines, as well as urgent care (which they want you to use instead of ER.) Then they stiff you $300 copay for an ER visit... which, considering that's still a fraction of the cost of an ER visit, isn't quite so horrible. Our max dedictible is $5000.

What stinks is my dental insurance. It's $1000 benefit a year. Once the benefit runs out, you're on your own. Heaven help us if someone needs oral surgery...

Co-Pay: think going in on something with someone; "You pay $15 up front, and I'll cover the rest later".

Deductible: Most places, Co-Pay has nothing to do with deductible. For instance, I visit the doc once a month (and pay my co-pay, get my perscription refill, go get my meds, and wait 29 more days). However, I had to get an MRI about a week ago and imaging/radiology has a deductible ($250 in my case). Since I had nothing else in the imaging/radiology department, I had to pay my deductible. Just like with car insurance, if you are in an accident, you pay your deductible and they take care of the rest. After your deductible is met (and UN-like car insurance,) you start doing a co-pay on that service (most places).

Out-of-Pocket: Most places have a maximum out-of-pocket expense you can incur (co-pays don't count towards it, prescriptions don't either, and many places don't count deductibles...) and likewise a maximum coverage amount you're screwed if you go over. For instance, your maximum out-of-pocket may be $5k. If you end up with $10k in hospital stay expenses, the $5k after you pay the first $5k will be handled by insurance.

The problem is, every place handles it differently, and you have lawyers and legal people involved, etc. etc.

I once had insurance where you straight paid everything until you hit $2500 and then you got into co-pays and deductibles and stuff. It's a big ******* mess. I hope that vaguely helped.

I wasn't looking for an advertisement, nor was I shopping for insurance. I was asking what my current package means. Thanks for nothing, though.

$420/month for myself and my sister.

Christ. Forget I asked. Health, dental and vision for the 5 of us is about $220 a month.