Without that discount, people often pay twice as much - or more - for care.įor details about your deductible, log in to Blue Access for Members SM (BAM SM). Insurance companies negotiate their rates with providers, and you’ll pay that discounted rate. Q: If I pay so much out of pocket before my insurance kicks in, why should I have coverage?Ī: Health coverage can lower your costs even when you must pay out of pocket to meet your deductible. They’d rather have a higher premium, but a lower deductible. Other people like knowing that when they need their insurance, they won’t have to come up with a large sum of money before their plan starts helping with the cost. But it can mean taking a chance that you might end up paying a big medical bill if you have an unexpected illness or injury. Some people who don’t often need medical care would rather have a smaller premium and pay more up front for care as they go. You’ll pay more each month, but your plan will start sharing the costs sooner because you’ll reach your deductible faster. The lower a plan’s deductible, the higher the premium. If you’re willing to pay more when you need care, you can choose a higher deductible to reduce the amount you pay each month. Q: What are the pros and cons of a high or low deductible?Ī: In most cases, the higher a plan’s deductible, the lower the monthly premium. This might include such things as cosmetic procedures or seeing a provider who isn’t in your health plan’s network. If you receive care that isn’t covered by your health plan, it often won’t count toward your deductible. Because you don’t have an out-of-pocket charge, those services won’t count toward meeting your deductible. Some plans fully cover preventive services, which means you don’t pay anything at the time you get them. Q: Do all health care services apply to my deductible until it’s met?Ī: Not always. Check your benefit details if you aren’t sure. Some plans, like a health spending account (HSA) may only have a family deductible, so your member ID card will only list one deductible. After the family deductible is met, you’ll only pay your copay and/or coinsurance amount for services for each family member. With a family deductible, once you met that one family deductible amount, no other individual deductibles are needed. If each person had to meet an individual deductible, you would pay all the deductible amounts before your coinsurance started paying. You all need to get checked at the hospital for injuries. That’s the case even if some family members haven’t met their individual deductible. As soon as the family deductible is met, your plan starts paying at the coinsurance amount for everyone’s care. What does that mean?Ī: If your plan covers your family, there will probably be a deductible for each person and a separate family deductible. Q: My plan information says I have a family deductible, too. For example, your plan may cover the cost of annual physicals and many preventive health screenings before the deductible is met. Q: Is a health insurance deductible different from other types of deductibles?Ī: Unlike auto, renters or homeowner insurance where you don’t get services until you pay your deductible, many health plans cover the cost of some benefits before you meet the deductible. If you’ve met your deductible for the year or are close to meeting it, you may want to squeeze in some other tests or procedures before your plan year ends to lower your out-of-pocket costs. Since your deductible resets each plan year, it’s a good idea to keep an eye on the figures. Does the deductible reset each year?Ī: Yes. Q: You said a deductible is the amount you pay each year. For example, if your coinsurance is 80/20, you’ll only pay 20 percent of the costs when you need care. Coinsurance is when your plan pays a large percentage of the cost of care and you pay the rest. Q: What happens after I meet the deductible?Ī: Once you’ve met your deductible, you usually pay only a copay and/or coinsurance for covered services. And some types of medicines may be available at a lower cost (as little as $0), even if the deductible has not been met first. Then you will pay your copay or coinsurance amount until you meet your yearly out-of-pocket maximum. ![]() This means you will pay the prescription’s full cost upfront until the deductible is met. For example, if you have a $1,500 deductible, you pay the first $1,500 of the services you need.ĭepending on your plan, you may also need to meet this in-network deductible before you pay for covered prescription drugs. They’re important to your pocketbook, but do you know how they work? To get you started, here are answers to some common questions we get from our members.Ī: A deductible is the amount you pay for health care services each year before your health plan starts to pay. It helps to know what questions to ask and where to find the information you need.
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