4 Things to Look for in Your Health Insurance: #4 Deductible

What should you look for in a plan? 1) Max Out-of-Pocket 2) Network Types: PPO, HMO, EPO, POS 3) Monthly Premium 4) Deductible

What is a deductible?

A deductible is the amount of money that you have to spend before the insurance company starts to pay claims and provides coverage. Some insurance companies have exceptions for preventative care.

What is the difference between a deductible and a max-out-of-pocket?

The max-out-of-pocket is the most you will ever have to pay within a given year. The majority of the time will include the deductible.

For instance:

You have a concussion and it costs $15,000 for everything.

You will pay your deductible first, let's say $7,000.

Then typically a co-insurance, let's say your co-insurance is 80/20 meaning that you will pay 20% of the bills until you reach your max-out-of-pocket and at that point - the insurance company will then pay 100%. Let's say your max-out-of-pocket is $9,000.

So the sequence would work like this:

First your deductible, $7,000

Then your co-insurance 20% until your 20% equals $2,000 (The difference between $7,000 and $9,000)

Then your insurance company will pay the rest at 100%

For the rest of the year, since you satisfied both the deductible and the max-out-of-pocket then all covered claims will be paid by the insurance at 100%

Ultimately, you want as low of a deductible as possible but the most important is a max-out-of-pocket!

Nothing but love,

Agent Gina Knight

Senior Licensed Advisor

Here to help protect you, your family, your health & your assets.

Direct: (813) 644-0406