I just received my family’s spanking new health insurance cards - we haven’t all been covered as one unit in many, many years. Even though we have a “deductible” of 2k per person/4K as a family, my cards do note our member co-payments for various services, including $0 for a routine physical, $25 for a well child care visit, etc.
I did read our (excrutiatingly poorly-written) member benefits booklet, but couldn’t find an answer to these questions: Say I call my doctor and set up a routine physical as my first service on the insurance. Am I paying the actual cost of the appointment (given that it would probably be less than 2K), or am I paying nada? Is the deal that the deductibles are for the actual co-pays themselves - say, once I have paid the deductibles’ worth of co-pays for the usual type of medical visits, then any further visits are basically free? (Does that last question even make sense?!?)
Thanks in advance for any/all replies. It’s been many years since my hubby and I have had any sort of health coverage, and I can hardly afford the full cost of a doctor’s visit right now!
Caveat: My plan is not your plan. Call the number on your insurance card and ask someone there.
With the plan I currently have, I pay nothing my normal yearly checkups (all-over physical and GYN stuff), and the cost that is covered by my insurance company does not apply toward my deductible. So, say that the visit would cost $500 and I have $1,000 left on my deductible: I pay nothing, my insurance pays $500, and my deductible is still at $1k.
Yeah, you have to call your insurer if the benefits booklet doesn’t make it clear. In shopping around a couple of years ago, I saw plans that:
had a co-pay and a deductible. So the co-pay was due whether they were going to cover there st of the cost or not.
had a co-pay for certain wellness benefits that was often two to four general check-up appointments per year. The insurance paid for these whether you’d reached your deductible or not, as a way to encourage you to keep regular check-ups.
Absolutely, Shot From Guns - I should just call the number on the card but I have had my kids and their friends literally running throughout the house for hours now and can’t concentrate on the spoken word in the meantime. I suspect that my plan would work similarly to yours, then. Thanks!
Oh yes, I’ve noticed that those “Health Insurance for One” plans, at least, manage to encompass a mish-mash of deductible/co-pay requirements; my new plan, however, is from my employer, so no shopping around was necessary on my own initiative.
With any luck I’ll be able to reach someone after business hours to clarify (as a teacher, I can’t call during the day).
My health insurance specifies everything as being either “no deductible” or “after deductible”. Which is a very important distinction.
Office visits for example have no deductible, so we pay only 15% of the bill from the start. That 15% does not count against the deductible, but does apply to the out-of-pocket maximum.
OTOH, hospital visits are specified as after deductible, so we pay 20% of the bill after the first $700 or so.
So your plan details may vary, but generally I would hope preventative care would be in the “no deductible” category. Otherwise the low co-pays wouldn’t really be much of a motivation to get those things done.
Aye, that is indeed a very important distinction. Now that you mention it, many of the benefits listed on my plan state “$(insert astronomically high number here) after deductible.” Others, such as the aforementioned routine physical, don’t say anything at all about any potential effect on the deductible. Thus my confusion. :smack:
Actually, I was shopping for a group plan (myself, my wife, and two employees at the time). I intentionally picked one that was simpler at least in part so that employees didn’t have to remember all the details.
Details + an ADHD-addled brain*, such as I seem to have, don’t tend to mix too well. I hope your employees appreciated your selection.
*My heretofore undiagnosed ADHD is a big reason why I feel a need to visit the doctor in the first place. I thought my being scatterbrained, inattentive, and easily distracted were just the way I was made. But then I had my kids, who themselves have ADHD, which is when I realized th… ooh look! A kite!
Obviously plans vary - but as others have said, I’d bet routine stuff is all covered with a per-visit copay (or in the case of preventive care, it’s free).
My plan this year has a deductible - but office visits aren’t subject to that at all. The deductible would apply to things like procedures (surgery etc.), equipment (my new orthotics), and probably a few other things. Preventive care is covered 100% - my mammogram and the kids’ well-child visits were free.
