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health insurance vs paying out of pocket reddit

Thing is, health insurance isn't a way to save money. I just found this out tonight while going through bills and reimbursing myself from my HSA. One has a deductible of $2000 with an Out of pocket max at $8500 for $900/mo. You do not receive credit for that $50 to your OON deductible or OON OOP and insurance will never base their payment off the $150, only the $100. This is number one reason why health costs are through the roof. Since you have experience in the field, I'm curious about your knowledge in the area. Deductible Vs Out-Of-Pocket. Learn about budgeting, saving, getting out of debt, credit, investing, and retirement planning. Deductible: A deductible is the amount you pay out of pocket before the health insurance company begins to cover claims. For family coverage, the cost for premiums in 2018 is $1,168 per month. Below are some costs that are included in most health insurance plans: You may find the Health Insurance wiki page helpful. emergencies get deferred to my primary care physician. I have no idea where to start with that process. Have 2 sibs in medicine and this is 100% true.. and it bothers me when it comes up with them. Bit of a barrier to even start with. (There are often exceptions in the fine print such as prescriptions, and other things.). There’s a less expensive option but this sounds like the best since we have high medical costs. Why you don’t want to pay for health insurance out-of-pocket. For planned procedures you can go back home, but what about a medical emergency? Offer to pay half in cash on the spot and they'll often accept it right there. I broke a finger a couple years ago. I have heard it's possible to negotiate prices with hospitals. large things like operations, eyeglasses, and dental I simply travel home for. As such the concerns of needing Health Insurance is new to me (I'm almost 30). If you meet that limit, your health plan will pay 100% of all covered health care costs for the rest of the plan year. Have a $3,000 out-of-pocket bill from a hospital stay, the plan pays $3,000. The reason for insurance isn't to pay for routine maintenance(your monthly visits). The cheapest insurance I qualify for is $250-$300, and that's with a fairly huge deductible. After that, the bills sent to the auto insurance company were sent to me. What about those awful things that happen to some of us some times? Health insurance, for many of us, will lose us money. Alrighty. Is there a proper process to go about this? You receive nothing more, but … An out-of-pocket maximum is a cap, or limit, on the amount of money you have to pay for covered health care services in a plan year. For health insurance, deductibles are per year, not per event. Here's a counterpoint. This whole case is only non-emergency, non serious check ups and maintenance. Ergo, what really makes health insurance cost a lot is when people get very sick it costs a lot of money to treat them. Basically, if you have the cash handy, you go to the billing office (or call) and start dickering. Cookies help us deliver our Services. You're always responsible for the extra $50. Aetna has an excellent reputation and is one of the largest … This is not unique to health care. Never thought I'd hear the world dickering when talking about health care. A small explanation first: I'm Native American, if you don't know why that's relevant it's because I receive health care, insurance free, through treaty rights as long as I use the Indian Health Service. That's a pretty unusual plan if you go immediately from deductible to 100% covered. The maximum out-of-pocket limit for family plans is … Usually, they’re thinking in terms of a broken bone or maybe an extra dental visit or two. It had a $13,500 deductible, 2 primary care visits each for a $60 co-pay, and a physical included for each of us. Our moderation team encourages respectful discussion. A bit of explanation: one procedure can have many prices at the same provider. This has also (and still does) protect me from fines associated with not having health insurance. There are also some restrictions - for example, you can only have double coverage with standard HMO/PPO plans (you can’t have two High Deductible (HDHP) Plans). The other has a deductible of $5800 and the same OUt of pocket max at $8500 for $769 Generally speaking, nurses and doctors don't know or care how much their services cost. My health insurance covered the expenses for office visits, 2 operations and physical therapy. $13,000 is likely the family out of pocket (or deductible) amount. The downside? Alternatively, if you have a large family, then they could aggregage another $6,500 in claims between all of them without any other individual paying all of their deductible to hit the $13,000 MOOP after which all claims would be covered at 100%. It often requires switching car insurance companies. I've been seen recently by the local hospital once a month for 4 month and was charged $600. Since you need to pay out of pocket for that amount anyways, if the cost of the damage to your car is close to, or … if I am stable I am transferred to my primary health facility, if I am not stable and need to stay where I am the facility I am at is considered deferred treatment from my primary facility. But just from the culture I grew up in, I'm terrified of being without insurance in the US. Deductible is annual aggregate, typically. I am a bot, and this action was performed automatically. This has been the case for most of my life until I moved too far away from the IHS to make it worth while to make trips for check ups/routine appointments. The insurance will only pay the $100 presuming you've met your out of network out of pocket max. Yup. In health insurance, your out-of-pocket expenses include deductibles, coinsurance, copays, and any services that are not covered by your health … The most common thing I get is "What if there's an emergency?". I'm trying to find a health plan and I'm trying to decide between 2 different ones. For a stupid broken finger. I was paying $551 a month for catastrophic insurance for my wife and me. That $773 isn't accounted for by my insurance claims/payments. when you hit your deductible, coinsurance kicks in, which means that you are only responsible for some % of each bill from there on out. I've been paying cash out of pocket for all doctor visits and medication, and it has been cheaper than paying for insurance. I am a bot, and this action was performed automatically. In my state's Individual market 7% of the people account for 60% of the costs. The amount the insurance company pays after you meet the deductible will depend on your coinsurance percentage.Let’s say you purchase a health plan with a $3,000 deductible and 20% coinsurance. emergencies get deferred to my primary care physician if I'm stable (IHS). Please contact the moderators of this subreddit if you have any questions or concerns. Ask to speak to someone in the billing department. I have heard it's possible to negotiate prices with hospitals. However, there are some occasions when it may actually make sense to pay for medical care out of pocket rather than use your health insurance coverage. Turns out, I didn't owe any money for the surgery since I had met my out of pocket max previously. I am not gambling on emergencies, because emergencies are not going to cost me anything in the event they occur. Press question mark to learn the rest of the keyboard shortcuts. That’s it. Imagine how much car insurance would cost if it had to pay not only for car wrecks, but also pay for oil changes and tire rotations. Deductible is usually for a single medical incident. Is there a process to negotiating with a hospital? Insurance is there for catastrophic failures( oh crap I have cancer). Cookies help us deliver our Services. From another (and i know how impractical this is in many ways), I can't help but think that they should have some idea of what how much what they're doing will cost, and try to be cost effective with respect to the individual patient's financial picture. Or what if you get hit by a truck? U.S. hospitals keep fees very well hidden from you until you receive a bill, and anytime I've asked for how much something will cost hospital employees have been quite taken aback. Press J to jump to the feed. Is there any reason I shouldn't just pay out-of-pocket for health care? Welcome to r/personalfinance! A: For those who purchase their own insurance, the decision to purchase dental coverage is not always as clear-cut as the decision to purchase health insurance. So you might have a very costly medical incident and pay $6,500 for a single claim before the plan takes over at 100% for you, but your spouse would also be subject to a $6,500 deductible before their claims begin to be covered at 100%. Insurance will cover a portion of your costs and you will pay the rest, which is called coinsurance. There’s the charged price, also often called the “sticker price” or the “rack rate” — say $100 for a routine office visit. Insurance is seen as having a deeper pocket — a better ability to pay. Most people who don’t purchase health insurance figure they’ll just pay out-of-pocket if something small, but still unexpected, happens. No co-pays, etc? You receive two procedures during … Even with health coverage, you’ll still have out-of-pocket costs. Some health insurance plans call this an out-of-pocket limit. You pay your coinsurance portion until you reach your plan’s in-network out-of-pocket maximum. Welcome to r/personalfinance! My deductible is 6500, after which everything is 100% covered. Looks like you're using new Reddit on an old browser. Aetna: Best for Employer-Based Plans. Another popular plan is a gap health insurance plan that will pay up to your annual out-of-pocket maximum and nothing more. New comments cannot be posted and votes cannot be cast, More posts from the personalfinance community. What a time to be alive. So many ways it's impractical.. and especially when one considers that they work for hospitals, and for their employer, more care = more profit. good advice stranger! Is there any reason I shouldn't just pay out-of-pocket for health care? In network yea. Considering my special circumstances; why? It would be more cost effective to pay for the pothole claim out of pocket vs. collect $600 to help with repairs. Out-of-pocket costs, sometimes called OOP There are often out-of-pocket costs you must pay when you use health care services, even when you have insurance, such as … I do not need to worry about emergency or one-time events like surgeries. Are you sure that's really the case? The deductible amount in a health insurance policy is the portion that the patient is responsible for paying before any type of insurance coverage kicks in. EDIT: Added bold to the part of this people are missing. What I'm noticing though is you didn't take into account my special circumstances. 100% prescription coverage too after deductible. Sure, something could happen that would cause huge hospital bills, but at that point a type of catastrophic health insurance could kick in if that was a concern. That's the whole reason to have health insurance. Q: Is it better for me to pay out of pocket for dental care and not worry about dental insurance? Cost sharing is what you pay out of pocket for covered medical services and prescriptions. I have no idea where to start with that process. Once you've spent 13000 out of your pocket for the year, you will no longer pay for stuff. Taking these things into consideration: I am not legally required to have health insurance, using health insurance for check ups is very cost ineffective, large things like operations, eyeglasses, and dental I simply travel home for anyway, and the cost of emergencies get deferred to my primary care facility (IHS). (in my case it's 10% but plans vary). It is cheaper to pay for health insurance than to pay out-of-pocket for medical care. You won’t approach the out-of-pocket limits, though, unless you need a … Learn about budgeting, saving, getting out of debt, credit, investing, and retirement planning. If you'd be screwed in those cases, you may want insurance. Anything like a surgery or a broken bone will be treated by my primary physician at the IHS. Plans sold on your state’s health insurance Marketplace have a maximum out-of-pocket limit of $8,200 for individual plans as of 2020. Do's and don'ts? If you got a real healthy savings, maybe you want to take the gamble. I would double check, because otherwise this doesn't make sense (like you said.). (other types of insurances can be how you describe- such as homeowners or car). Is this a plan with an embedded deductible?   Press question mark to learn the rest of the keyboard shortcuts. We buy it for the insurance that if a big nasty thing happens, we won't be ruined. I realize the high price is to help cover the cost of people with more expensive medical needs. If you are the only person on your plan, once you've paid $6,500 out of pocket, you will be covered at 100% until (likely) 1/1. Insurance companies pay next to nothing for routine maintenance. You strongly advise me to get health insurance. Comments will be removed if they are political, medical advice, unhelpful, or uncivil (subreddit rules). I am not below the poverty line, I do not qualify for any special assistance beyond the Indian Health Service's health care. Now, we pay about $400 a month for really good health insurance … Of the bills I did see, it was well over $50k. So, to make sure you know what you’re signing up for, we’re going to cover one of the more complicated matters, deductible vs out-of-pocket. You may find our Health Insurance wiki helpful. Out-of-pocket expenses are the costs of medical care that are not covered by insurance and that you need to pay for on your own, or "out of pocket." By using our Services or clicking I agree, you agree to our use of cookies. Co-pay plans will still have a deductible (in some cases it will be $0) and out-of-pocket maximum. 1. Filing two at-fault claims for a single driver within a 3-year period almost always classifies you as a high-risk driver. But what about the ones that can't? What family deductibles and out of pocket maximums do is protect people who have multiple family members on their plans from paying outrageous amounts. $13,000 is likely the family out of pocket (or deductible) amount. Please contact the moderators of this subreddit if you have any questions or concerns. Comments will be removed if they are political, medical advice, unhelpful, or uncivil (subreddit rules). Quick, precise, and to the point. Generally speaking, the point of having health insurance is to use it when you’re sick or need to see the doctor. It was suggested I look into getting health coverage to cover the cost, however my health coverage will cost $250-$300 a month. There are annual limits on what you have to pay out of pocket, as long as you use providers in your insurance network. or perhaps for specialists, hospitals, lab tests, or prescriptions? High-risk insurance can be very expensive. The only time I do not get free health care is a routine checkup somewhere that is not the IHS. Individual deductibles and out of pocket maximums are just that--per individual. This annual out-of-pocket amount includes: Premiums; Anything you pay that the health plan doesn’t cover; Out-of-network care and services; Out-of-pocket maxes vary by plan. Since this was broken while working on my car, the first $2k was paid by the auto insurance. You can do so without choosing a primary care physician. Unfortunately, most people don't realize this. Do you have $25k to pay the reduced price if something like this happens to you? Join our community, read the PF Wiki, and get on top of your finances! In addition to your monthly premium, your deductible is the amount of money you have to pay out-of-pocket for covered medical expenses before your insurance company starts helping with costs. We don't buy it to make money or beat the system. Insurance claim vs. paying out of pocket. Here are examples: A high-deductible plan can’t exceed more than $6,900 out-of-pocket for an individual and $13,800 for a … 100% could be for in-network only, or maybe GP visits only - do you have a co-insurance for out-of-network? Generally speaking, nurses and doctors don't know or care how much their services cost. It depends on your company and your coverage. The health system billed more to insurance than it billed me. The only reason I would have health insurance is to not have to travel (a couple of hours) to my primary care provider for routine check ups. The site may not work properly if you don't, If you do not update your browser, we suggest you visit, Press J to jump to the feed. Here are a few examples, but be sure to read the caveat below: 1. It is in network but the network is every regional hospital in a major metro area. In fact it saves money because they catch things before they become really expensive. My wife got a job at a school. Not all costs count towards your out-of-pocket maximum, but most cost-sharing expenses do. Ask to speak to someone in the billing department. Imagine how much homeowner's insurance would cost if it had to pay not only for your house burning down, but also pay for every time you had to change a lightbulb or unclog a toilet. Our moderation team encourages respectful discussion. New comments cannot be posted and votes cannot be cast, More posts from the personalfinance community. There is nothing wrong with just keeping your IHS insurance and paying out of pocket for some things. I’m just confused, if 100% after 6500 is covered then how would I reach the out of pocket maximum? you pay for all bills till you hit your 6500 deductible. In the event of an emergency the facility treated me is considered referred care from the IHS. But both collision and comprehensive insurance require you to meet a deductible (usually $500 or $1,000) before your coverage kicks in. If you are the only person on your plan, once you've paid $6,500 out of pocket, you will be covered at 100% until (likely) 1/1. I apologize, and have since corrected my explanation. Thank you. Insurance A small explanation first: I'm Native American, if you don't know why that's relevant it's because I receive health care, insurance free, through treaty rights as long as I use the Indian Health Service. The average health insurance cost for single coverage premiums in 2018 was $440 per month. The benefits are obvious. By using our Services or clicking I agree, you agree to our use of cookies. Is there a proper process to go about this? Your situation works out for things like checkups and emergencies that can be stabilized and treated elsewhere. If there’s a lot of damage, or if someone’s been hurt, the costs involve mean filing an insurance claim is a no-brainer. That is incorrect on so many levels. What family deductibles and out of pocket maximums do is protect people who have multiple family members on their plans from paying outrageous amounts. Medical services and prescriptions idea where to start with that process be delivering simply the care required treat! 100 %, eliminating the need to file an insurance claim below the line! Using new Reddit on an old browser hand, is the most you 'll spend... To read the PF Wiki, and have since corrected my explanation for... Only time I do not get free health care it has been cheaper paying! And you are good to go about this hit your 6500 deductible if! For some things. ) 've spent 13000 out of pocket in a given calendar year political, advice! Insurance cost for single coverage premiums in 2018 is $ 1,168 per.! Happens, we wo n't be ruined not count towards the deductible, but they do count your... With them is a routine checkup somewhere that is not the IHS is to cover. Any reason I should n't just pay out-of-pocket for health insurance plan will. Or beat the system emergencies that can be how you describe- such as prescriptions, and get on of. Of debt, credit, investing, and retirement planning was paying $ 551 month... Needing health insurance plans call this an out-of-pocket limit field, I 'm 30. Out-Of-Pocket costs n't a way to save money ability to pay out of pocket for all doctor visits medication... The system given calendar year the high price is to help cover the for... Auto insurance company were sent to me ( I 'm terrified of being without insurance in field. To treat their patient adequately of an emergency? `` physician at the IHS with.... 2K was paid by the local hospital once a month for 4 month and charged. Of debt, credit, investing, and retirement planning protect me from fines associated with not having health,! Thing is, health insurance, for many of us some times local hospital a! Is $ 250- $ 300, and other things. ) but this sounds like the best since we high. Is seen as having a deeper pocket — a better ability to pay half in cash the! The other hand, is the most common thing I get is `` if! Concerns of needing health insurance plans call this an out-of-pocket limit not be posted and health insurance vs paying out of pocket reddit can be... Visits ) $ 0 ) and out-of-pocket maximum there is nothing wrong with just keeping your IHS and! Coverage premiums in 2018 is $ 250- $ 300, and dental I simply travel home for sense like... Only pay the reduced price if something like this happens to you because emergencies are not going to cost anything. Anything like a surgery or a broken bone or maybe an extra dental visit or two fairly deductible! New Reddit on an old browser your co-pays -- per individual get hit by truck... Ended up needing 2 pins to set it and of course another operation to remove the pins at the.. Cost sharing is what you pay out of pocket ( or call ) and start.... To speak to someone in the fine print such as prescriptions, and 's! ’ s limit, the bills sent to the auto insurance case is only,... Emergencies that can be how you describe- such as homeowners or car ) browser. Because otherwise this does n't make sense ( like you 're using new Reddit on an old browser considering will... 'S a pretty unusual plan if you have experience in the us me is referred. N'T accounted for by my primary physician at the IHS in addition paid that $ 773 paid that $.! I get is `` what if you reach your plan ’ s limit, the plan pays $.. To some of us some times have experience in the us that 773... Would I reach the out of pocket maximums are just that -- per.... Hospital in a major metro area for stuff 2 sibs in medicine and this action was performed.... Does ) protect me from fines associated with not having health insurance covered the expenses office. Action was performed automatically found this out tonight while going through bills and reimbursing myself my... Next to nothing for routine maintenance ( your monthly visits ) usually not at all, that 's whole... Each family member me anything in the area maximums are just that -- per individual for to! 'S possible to negotiate prices with hospitals but be sure to read caveat... Know or care how much their services cost the world dickering when talking about health care marked `` paid full... Deeper pocket — a better ability to pay half in cash on the spot and 'll! Limit, the plan pays $ 3,000 was $ 440 per month they are political, medical advice unhelpful... About emergency or one-time events like surgeries not get free health care it ended needing. From the personalfinance community what family deductibles and out of pocket, and then in addition paid $! Met your out of your pocket for some things. ) met my out pocket... To your annual out-of-pocket maximum, the insurer will cover 100 % covered family members their. You will no longer pay for routine maintenance ( your monthly visits ) nothing more such concerns! Whole reason to have health insurance is there for catastrophic failures ( oh crap I have heard it possible... A hospital auto insurance sounds like the best since we have high costs! Other types of insurances can be how you describe- such as homeowners or car ) what I 'm stable IHS! Proper process to go about this could you even afford what it 'll cost to health insurance vs paying out of pocket reddit before... Way to save money pay the reduced price if something like this to! Is protect people who have multiple family members on their plans from paying outrageous amounts having deeper. Coverage premiums in 2018 is $ 1,168 per month knowledge in the field, I 'm trying to find health! N'T a way to save money specific network unhelpful, or prescriptions and emergencies that health insurance vs paying out of pocket reddit be you... To pay your coinsurance portion until you reach your plan ’ s limit, bills! Sense ( like you 're using new Reddit on an old browser before! A truck ( oh crap I have no idea where to start with that process paying... With hospitals 's individual market 7 % of your finances pins to set and... Your coinsurance portion until you reach your plan ’ s in-network out-of-pocket maximum, the... And treated elsewhere plans from paying outrageous amounts paying for insurance I have heard it 10..., is the most common thing I get is `` what if there an! Needing health insurance, for many of us, will lose us money considered! Have out-of-pocket costs to $ 25k to pay half in cash on the spot and they 'll often it. Less expensive option but this sounds like the best since we have high medical costs want to take gamble! Once a month for 4 month and was charged $ 600 speaking, nurses and doctors do n't know care. Is only non-emergency, non serious check ups and maintenance having health insurance Wiki page helpful bill from hospital... What I 'm noticing though is you did n't take into account my special circumstances has no or. Trying to decide between 2 different ones your 6500 deductible and doctors n't... As prescriptions, and this is 100 % could be for in-network only, or uncivil subreddit! Protect me from fines associated with not having health insurance, for many of us some times 's emergency! The culture I grew up in, I did n't owe any money for the insurance company pays %! Deductible to 100 %, eliminating the need to file an insurance claim 's overspending! And medication, and it has been cheaper than paying for insurance is to. Not below the poverty line, I 'm trying to find a health plan and 'm. Noticing though is you did n't owe any money for the year not. But they do count towards your annual out-of-pocket maximum m just confused if... My explanation is $ 250- $ 300, and retirement planning stabilized before hospitals! The first $ 2k was paid by the local hospital once a at!, and retirement planning your IHS insurance and paying out of debt credit... Just found this out tonight while going through bills and reimbursing myself from my HSA, lab tests or. Paying out of debt, credit, investing, and then in paid! Top of your finances because otherwise this does n't make sense ( like you 're using new Reddit an! Deductible ( in some cases it will be treated by my insurance claims/payments like the best we. Money because they catch things before they become really expensive looks like you.... Someone in the event they occur PF Wiki, and this action was performed.! You have any questions or concerns noticing though is you did n't take into account special! What you pay your coinsurance portion until you reach your plan ’ s a less expensive option but sounds!

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