There’s a certain amount you’re expected to pay per year before insurance will kick in for larger expenses. Called a deductible. And then there’s the out-of-pocket maximum, which is somehow different from a deductible. Oh, and the copay, which is the amount expected from you for routine things like checkups, therapy, and other appointments with certain in-network doctors. Out of network doctors, depending on the plan, will generally not be covered by insurance but will count towards a special out-of-network deductible amount. Unless it’s an emergency, then federal law states those expenses must count towards your normal in-network deductible.
Yes, it’s confusing. It is like that on purpose.
I’m lucky enough to be on my mom’s insurance still at 23, and because she works for our county government she has the privilege to have the option to pay for gold-standard insurance coverage. Couldn’t tell you what our deductible or out of pocket maximum is, but I can say my co-pays are generally $20 and I’ll pay anywhere from $0-$20 when I pick up a prescription depending on what coverage tier it falls under.
Nope, apparently they have to pay for private insurance (or not pay but have it included in what their employer pays for them instead of to them) and still have to pay for things out of pocket, even if their insurance accepts their expenses.
Meanwhile in Canada, I only worry about whether I had coins to pay for parking if I was at the hospital.
I had an appendectomy last March, my total portion was $7k, with “decent” insurance. Total bill was $169k for surgery & a one night stay.
What? Non American here, I thought if you had insurance you didn’t have to pay for things like that.
Appendectomies just come out of our collective taxes. I’m sure they couldn’t possibly be costing $169k each to produce or we would be bankrupt.
:)
There’s a certain amount you’re expected to pay per year before insurance will kick in for larger expenses. Called a deductible. And then there’s the out-of-pocket maximum, which is somehow different from a deductible. Oh, and the copay, which is the amount expected from you for routine things like checkups, therapy, and other appointments with certain in-network doctors. Out of network doctors, depending on the plan, will generally not be covered by insurance but will count towards a special out-of-network deductible amount. Unless it’s an emergency, then federal law states those expenses must count towards your normal in-network deductible.
Yes, it’s confusing. It is like that on purpose.
I’m lucky enough to be on my mom’s insurance still at 23, and because she works for our county government she has the privilege to have the option to pay for gold-standard insurance coverage. Couldn’t tell you what our deductible or out of pocket maximum is, but I can say my co-pays are generally $20 and I’ll pay anywhere from $0-$20 when I pick up a prescription depending on what coverage tier it falls under.
Nope, apparently they have to pay for private insurance (or not pay but have it included in what their employer pays for them instead of to them) and still have to pay for things out of pocket, even if their insurance accepts their expenses.
Meanwhile in Canada, I only worry about whether I had coins to pay for parking if I was at the hospital.
Off topic but are you really still using coins for stuff like that?
Sometimes, or I could use a card these days.
Is it bad that I read this and said “not bad?”
And then the insurance company talks them down to $20k after you/your employer pays them $50k over your lifetime