Please help me understand health insurance

So, its that time of year again. Health insurance is large in the minds of us folks living in the Guest House.
Looking at plan details, something I’ve never understood is individual deductible and family deductible.

How does that work? If I go to the doctor for whatever and pay my deductible does that go to the family deductible or individual deductible? How is it decided which deductible my money goes to? Do I have it all wrong and the individual deductible is for a plan with just a single person on it where the family deductible is the one I am liable for?

I don’t need or want a highly detailed and tailored to me specifically answer, just a basic overview please.

Good explanation here:

From here.

Ninja’d. Even the same link.

Please note the “most” in the article. My employer sponsored family plan only has a family deductible - it doesn’t kick in until I’ve met the full family deductible, regardless of whether it was all on one person or split among all of us. Read the description of the plan you’re considering for the complete answer.

aaah much thanks to all. I had pondered this and was never able to sift out an explanation as clearly written as that article.

Your medical bill goes towards your individual deductible and the family deductible. Once your individual deductible is met, the insurance kicks in for you. Once the family deductible is met the insurance kicks in for everyone in the family. The family deductible is normally lower than the sum of the individual deductibles.

There’s also the crazy situation where X number of family members need to meet their individual deductible before the family deductible is considered met. This type of policy is rare though.

Also note that most plans have “co-pays” for routine doctor visits, both to GPs and to specialists. Some plans also have co-pays for most drugs, especially generics.

A co-pay *is * money you’ll have to spend out of pocket. But it does *not *count towards meeting your deductible (individual or family).

Only spending on drugs, tests, or procedures above and beyond the co-pay amount for that event counts towards your deductible.

Last year I spent about $300 on co-pays for visits and pills, and that counted as exactly zero towards my deductible.

not to mention “co-insurance” which from looking at the details from the plans I was checking out means that even after you meet the deductible and all the other “out of pocket” bs, the insurance still aint gonna pay 100%

ok, going to stop now, venturing into imho or (more likely) pit thread ranting now.

No need for a rant. Its simply a process.

The idea is not to make all medical care free and unlimited. It’s to make the super-expensive stuff affordable to most while still providing a small amount of out-of-pocket cost to discourage frivolous consumption.

So there’s a graded scale where the more you consume the more you spend OOP, but at an ever-decreasing aggregate percentage.

The rest is just details of an imperfect system that has to sound sort-of fair when the same prices apply to a corporate VP and to a janitor.

oh the “co-insurance” thing isn’t really the object of my rant. A rant is just where I seem to go when talking about so called “health insurance” as it is in the US these days. For me none of the OOP is small, by the time I’ve met all the costs required for insurance to start paying, I’ve paid the bill entirely (if I can afford to after paying the premiums)

DAMMIT there I go…

Yeah. The problem is it costs the overall system $10K or more per year to both provide simple routine care and insure against the big stuff.

Which means for most folks it’s a real necessity that’s priced like a massive luxury. So we pay & grumble & scrimp on other “necessities” while hoping not to have to cash out on the catastrophic coverage.

It is not intended for you to understand it. It probably largely falls into the class of obfusca, as illuminated in this Rothschild Brothers’ of London communiqué to associates in New York June 25, 1863:

“The few who understand the system, will either be so interested in its profits, or so dependent on its favors that there will be no opposition from that class, while on the other hand, the great body of people, mentally incapable of comprehending the tremendous advantages…will bear its burden without complaint, and perhaps without suspecting that the system is inimical to their best interests.”

It’s important to be aware that different plans have deductibles that work differently as regards to your question. So you shouldn’t just find some website that explains it, or have someone else tell you how their plan works.

In general, a “true family” deductible requires you to meet both the individual deductible and the family deductible before the plan pays anything. An embedded deductible requires you to meet either the indivudual or family deductible before the plan pays. You need to find out how a specific plan works, and can’t just make assumptions based on the use of the word “deductible”.