What the Healthcare - Deductibles, Coinsurance, and Max out of Pocket
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- Опубліковано 12 вер 2024
- One of the biggest misconceptions in the health insurance industry. Give this video a peak and learn how it all works...OR of course, just call me anytime at 708-566-6589 to get any help with your health or life insurance needs
I am a licensed insurance broker, and a district partner for my company Healthcare Solutions Team. I am here to help ensure people make the best decision for their health insurance in their state. I am licensed in the following states currently:
AL, AZ, FL, GA, IL, IN, KY, LA, MD, MI, MS, MT, NM, NC, OH, OK, PA, SC, TX, VA, WI
Feel free to call me at 708-566-6589
Email me here: jdavern@myhst.com
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/ healthcaremadeseimple1
/ ezinsurancejoe
/ healthcaremadesimple
Holy Cow! This helped so much. Some people are just great teachers and you are one of them. Thank you.
Great breakdown Joe! More plans should be explaining it in these terms. Also, I think employers should explain their plan comparisons this way - BRAVO!
I agree David. Most people have no idea what they are getting themselves into. Appreciate it man!
@@healthcaremadesimple5367 I was an analyst for a student health insurance broker back in '13 for about 7 years, and we were highly successful mostly for how we could explain our plans to our in terms of actual impact to the pocket. "If you have a broken arm..." is a really great place to begin (people are stunned that it costs >$$10K); we'd used Diabetic treatment for chronic, and Lung Cancer for catastrophic. When we'd present to student committees. They understood this comparison better than a dry review of the various plan components.
So in other words the broken arm would of cost a fraction of what it cost with insurance. For example, if the person with the broken arm had insurance for the last 10 years at a cost of $45,000 (120 months X $375per month = $45,000) and then broke his arm for an out of pocket cost of $4400 for a total cost of $49,400 with insurance ( $45,000+ $4400 = $49,400) . The cost of the broken arm without insurance would of been $10,000. Savings of almost $40,000 without insurance. Now watch how the defenders of insurance profits try to tear this basic fact of insurance being a scam apart.
I lost brain cells reading this you owe me some back lol
@@HawkMoonIGOTIT Thinking does that to low IQ people.
The years of having insurance will be greater than just paying for the broken arm yourself when it happens but people don't save up for emergencies. I think it should be a tax so everyone can go to the doctor whenever
@@HawkMoonIGOTIT That’s because the media and big companies shut most of your brain off for you.
Thank you! I'm a mental health therapist and have just opened a practice. Learning through brute force about insurance is painful, but you helped me understand a lot
Glad to be able to assist a bit
thanks for breaking this down in an intelligent, concise manner. I just got a insurance sales job with GoHealth here in Charlotte, NC and am currently trying to pass the NC Health exam to get certified.
Happy I can help Dan!
shabbirhealth.blogspot.com/2022/08/getting-to-grips-with-hormone-health.html
Glad I came across this video! I recently ruptured my eardrum with just a week before losing my insurance currently doing some shopping for new coverage and having you explain the different terms that I didn’t understand! I feel a lot more comfortable and what to choose! Thanks so much’
Best explanation i've seen of this. Thank you.
Thanks!
Just got into the business, this was a great breakdown! Tks!!
I speak Spanish and EXCELLENT thanks Joe
Thank you so much I am studying for my insurance license and this really help me to understand coinsurance
I don't know nothing before seeing this video but i got some idea after seeing the video such as co-insurance deductable out of pocket expenses.
Thanq so much bro ...👍
Happy to help!
Great video, thanks so much. For it. I do have a question Does pt has to pay out of pocket for every physician visit until out of pocket max is paid? Or only the copay is needed to be collected?
I think health insurance is a scam.deductibles are thousands of dollars if you pay only $200 per month. (Car payment) on top of that you still pay a fee for everything. Ive heard about health systems in denmark and canada where things are cheaper. For example seeing an specialist is always free, no stupid deductibles.
Thank you for this video !! Out of pocket is 🔑 I was looking at the a deductible of $1000 vs $2000 although the 2000 was 1k higher but it came with less oop & 10% less co insurance
You got it man!
At the time of training i really needed this knowledge to handle Florida blue patients information that is first priority to keep it safe and to get self explanatory for the sake of knowledge from your video itself.......And thanks sir for this nice video and basically I'm from India 🇮🇳♥️🇺🇲🤝
Working in an insurance company so here I am watching this 😅
In which?
@@austinben4524 United Health Care ❤
Joe ! Please give their definition as well and speak slowly. Actually in an interview, the interviewers ask the definition of Deductible, Copay, coinsurance, out of pocket, plan maximum, Medicare, medicaid etc. Sometimes they put questions for pointer, modifiers, units, grand father plan. Health plan data base. Please explain them one by one for your viewers.
As per website patient's deductible is $1200 and he met $400, his Out Of Pocket is $5000 and met $2500, patient is covered at 65% & co-pay is $200?. Select the right order.
a. Deductible = $600, OOP = $2500, Co-ins = 25% & Co-pay = $200
Select one:
b. Deductible = $800, OOP = $2500, Co-ins = 25% & Co-pay = $200
c. Deductible = $800, OOP = $2000, Co-ins = 35% & Co-pay = $200
d. Deductible = $800, OOP = $2500, Co-ins = 35% & Co-pay = $200
Helped me going into 2024 Nice video man.
I am a bit confused on when payments start to go toward the OOP Max. I have a few hundred toward deductible but a slightly higher amount toward the OOP Max (based on my portal). I thought payments don’t go toward OOP until after the deductible is met? 😊 so it’s deductible+oop that would be the total?
We are having our first baby so wanted to investigate, your video is very helpful. My OB started to collect payments last year, with a total of my deductible. So that once I have baby, my payments are instantly applied to meet this years deductible. Not sure if that’s common but it’s seems helpful. 😊
Strange system and too expensive
Thought I'd also add this was a great explanation. Thank you! I will be sharing
not related comment but im really into an insurance but how you perauade is how i see myself😇
Over the past 5 years between my company and myself paid close to 20k in premiums to insurance company barely used 2 k worth of it the company paid probably 350 dollars of my claims the last 4 yrs
My company puts 500 into this a yr that has paid for all my health claims not the insurance company
VERY helpful. Maybe you should be the head of the health care market place because they can explain ANYTHING. I think dental is the same but, quick video may be helpful if its different. Again, thank you.
Appreciate the kind words
so if you crack ur arm before ur deductible is paid and pay the rest of it after you’re injured do u still get 20-80% or whatever off??
Thank you this video was helpful you explained everything perfect . Simple and informative
You're welcome!
Crazy,, its actually cheaper to have no insurance,,, there are places that offer great discounts if you are paying cash.. well, here in NY that is...
NY is typically extremely difficult for insurance rates, and because they are so highly regulated, they do not allow many alternative options for coverage
Thank you for example and breakdown. I get it now !
Every other developed nation has a universal healcare system. Insurance is clearly a scam, but at least you can learn how to get screwed a little less.
very clear explanation.
thanks
No problem
How is it possible to meet out of pocket max but not deductible? I've met my max but still owe $76.69 deductible. Now for a procedure I'm told I have to pay the $76.69
So once you hit max OOP everything going forward is covered?
Yes, 100% covered by your health insurance as long as the service is covered of your plan.
Na, you still have to pay the copay. Haha. You pay again for your insurance, despite paying for it already. Lol
thank you sir..
Perfect explanation Joe. 🙏
Exactly what I was searching
What an amazing video. Thank you
Literally you have to break your arm go to ER pay deductible and max oop, then break your other arm during the same year so the insurance can start paying for the whole bill, otherwise you will be throwing free money to health insurance companies, because you basically pay for almost everything for the first broken arm, but if something very bad happen to you you will be lucky to have insurance if not you could end up with hundreds and thousands of dollars in debt
What happens if you max out the OUT OF POCKET? What happens then?
How does it work if the Deductible is higher than the Out of pocket? So 5k deductible but 2500 out of pocket? That would suggest you cant pay above 2500?
That would not be possible. If a plan is listed like that, it means that the deductilbe is $5000 and then their is an additional out of pocket fo $2500. So the max OOP would actually be $7500
I don’t go to the doctor much but I’m going to start going more (chiropractic, check ups, etc) but I don’t know which one to choose! I’ve had the BCBS 1500 plan but should I have 750 plan?
You didn't mention NY, New york in your states. Does it mean you won't be able to help the client from ny, i would to like to contact you if you do. THANKS
Joe, can you help me find a health insurance plan for my family?
What if your first medical bill is higher than your Max OOP. Do you just pay your OOP and the insurance covers the rest? I have a major 3 part mri this month and money is tight.
Wow glad I have kiaser my broken arm was literally free besides $25 co pay and $10 x ray. Whewww
How does one calculate the write off amount from a deductible or coinsurance? Is it the right question?
I have no idea what you mean here
Hi, if anyone is watching this video pls help me. What happens if the med bill is less than mi deductible?
Thanks for making this simple
My pleasure 😊
Health care should be free...
Great video! Thanks for sharing.
Thank you
Good joe
I'm shopping as we speak, and the coinsurance number that I'm seeing on the marketplace right now isn't detailed as both parts of the whole 100% (for instance 80/20%). Instead they're just shown as one number, 40% for example. This would be the percentage that I (not my insurance) pay right? Because I'm seeing a lot of Out of Network visits are listed as "100% coinsurance after deductible". I can't imagine an OON visit would be free
Hey Ken apologies for the delay. The deductible will likely be MUCH higher out of network which is the reason why they say 100% after deductible. As far as 40% coinsurance, the 40% is YOUR repsonsibility and the insurance company pays 60%
How is the deductible determined? Is it calculated depending on you total bill cost, or is a pre-set fixed number that you pay regardless of your total bill cost? So, in this example was the deductible calculated to 3,000 in light of the 20,000 bill, or is the 3,000 deductible a set number that doesn't change regardless of the bill?
Deductible is set by the plan itself
@@healthcaremadesimple5367 thank you for the reply and video. Everything made sense.
Do health insurances give you the option to pay those out of pocket expenses over time or do you have to pay them up front?
So I may not exactly know what I'm talking about... but I believe you are paying the hospital / doctors office for any remaining expenses insurance doesnt pay. With that said, it would then depend on the facility whether or not they do payment plans.
This is great
Hi, thanks for the video. I have a question. So using this situation, if the person has another 10k bill, he only needs to pay the remaining 1.6k OOP? And the rest will be covered by insurance? Thanks
You got it!
A major medical maximum of 500 000 means?
Thanks a lot. Keep it up
Just amputate the arm. Health insurance stresses me out I'd rather die. But that's probably my ptsd talking
Is a $200 deductable, 80% Coinsurance, and $1,000 out of pocket maximum ok insurance?
That is unbeatabale coverage
Is there is a plan like this?
Thanks from india
I have had 2 "in-network" procedures with thousands out of pocket and my summary does not count any of it toward my deductible or max. I'm looking at a 3rd surgery in a few months. I have tried to get answers as to why I still lack almost the entire amount and get the runaround. Is there a reason they wouldn't count health-related, in-network surgeries when my coverage says it should?
Maybe there should be an authorization before having a specific procedure.
How would this work if you are using someone out of network and you have a PPO that allows you to see other doctors that are out of network?
Depends on the plan honestly. Usually if you go out of network, the deductible could double or triple. Additionally, if you receive a copay for going in network, it will be much more expensive to see that doctor out of network
Great video, thank you so much!!
Glad it was helpful!
so your co insurance payments go toward your max out of pocket? and are they paid upfront at time of services?
Yes anything you spend in a given year accrues towards the plans max OOP.
Had a surgery and couple visits which I already met my $6000 maximum out of pocket with.
Ended up having another 3 say stay at the hospital for $50,000 due to complications.
I shouldn't have to pay any of this due to reaching my max oop?
so how did it go?
If oop is met and plan still shows ded remaining, should we consider 100percent coverage and ignore the ded ?
If you meet your max out of pocket you should be 100% covered after that
Thanks for your video
No problem!
In the same example will you plz explain the role of co-pay ??
I plan on making some more videos soon!
I think Coinsurance is calculated on the allowed amount.
Why I feel like .. from one end u look like Chris Evans
Only difference is I have much more muscle than he does!
Incredible and good to know 😁
what is a customary charge?
it means a charge made by the customer
use a lav or boom microphone please
you put your phone number on youtube!? BOLD MOVE
Handsome🥰
Country code for Joe
Very cute
I wonder if you still take calls, I just tried.
I do take calls Lee. Was a very busy week last week - please reach out again
@@healthcaremadesimple5367 Well, I have a new plan now but thanks anyway. I tried to channel what you were teaching into my new choice. I really appreciate the video.
Can I get Ur country code
It is a scam
Stop swaying back and forth, you're getting me motion sick.
Tamil
Thank you so much!!!!! 🥳🤎
No problem!!