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Debates Forum

Debates Forum

  1. Standard member caissad4
    Child of the Novelty
    21 May '14 06:42
    In my previous thread about the ACA I was unsuccessful in obtaining even a garbage health insurance policy. I was unable to complete the process due to numerous problems with the website and phone issues.
    But wait !!
    Today I received a packet from Humana telling me that I indeed have one of their truly garbage healthcare policies even though I NEVER completed the application.

    Sadly they didn't send me an actual insurance card.
    Big Brother must be watching out for me, lol.
  2. 21 May '14 16:50
    How much are you going to be stuck for before the insurance that you pay for kicks in? In other words, what is your deductible?
  3. 21 May '14 20:43
    Originally posted by Eladar
    How much are you going to be stuck for before the insurance that you pay for kicks in? In other words, what is your deductible?
    Just to clear the air, the deductible in most policies is the aggregate of co-pays before the policy pays the full amount of procedures.

    For example, your deductible is $10k. If you have a major surgery, and the copay is $10k, once you pay that copay, your deductible is satisfied. Then there are no more co-pays until the following policy period, usually annually. The deductible amount can usually be settled by any combination of co-pays or a single one.
  4. 21 May '14 21:16
    Originally posted by normbenign
    Just to clear the air, the deductible in most policies is the aggregate of co-pays before the policy pays the full amount of procedures.

    For example, your deductible is $10k. If you have a major surgery, and the copay is $10k, once you pay that copay, your deductible is satisfied. Then there are no more co-pays until the following policy period, usua ...[text shortened]... ly. The deductible amount can usually be settled by any combination of co-pays or a single one.
    That's not how this link explains it:

    http://www.staysmartstayhealthy.com/health_insurance_deductibles

    Your deductible is the amount of your medical costs that you have to pay before your health insurance takes over. Here's an example. Gary has a health plan with a $1500 deductible. If Gary only has a few little things go wrong during the year that cost less than $1500 total, he's going to pay the full amount to treat them. However, if Gary has a catastrophic injury or serious illness that requires a lot of medical care to get better, he'll pay his $1500 deductible and then his health insurance takes over to pay most if not all of his additional costs.

    There is a maximum pay out, but that is well beyond the deductible. If you have 80/20 insurance, the insurance company isn't going to start paying out it's 80% until you've met your deductible.
  5. 21 May '14 21:25
    Originally posted by Eladar
    That's not how this link explains it:

    http://www.staysmartstayhealthy.com/health_insurance_deductibles

    [b]Your deductible is the amount of your medical costs that you have to pay before your health insurance takes over. Here's an example. Gary has a health plan with a $1500 deductible. If Gary only has a few little things go wrong during the year that c ...[text shortened]... the insurance company isn't going to start paying out it's 80% until you've met your deductible.
    Not true. Medicare is 80/20. It pays its 80% from the start. My BCBS Medicare supplement has a deductible which is satisfied cumulatively by my co-pays, for example $15 to see my primary care doctor, or $45 to see a referred specialist. Co-pays on prescription drugs, also accumulate to satisfy deductibles.

    My explanation may not be true of every policy, but it is generally true of most. This is based on my understanding as a licensed health insurance agent in the State of Ohio for a period of 8 years.
  6. Standard member smw6869
    Granny
    21 May '14 22:34
    The deductible is what you pay out of pocket BEFORE the insurance starts to pay. In some cases, such as an HMO, there IS no deductible and the cost is shared by both the patient and the insurance company from day 1. So the patient has a co-pay right away but it's less than the cost of service. If the patient reaches the maximum out of pocket, the insurance pays 100%. So the deductible is at the beginning of the policy year when the patient owes 100%. Then it moves into a shared payment where the patient has a co-pay and the insurance pays something. Then the 3rd and last phase is the insurance pays 100%. Unless there is a lifetime max in which case the patient has no more insurance. Just sayin'.

    GRANNY.
  7. 21 May '14 23:11
    Originally posted by smw6869
    The deductible is what you pay out of pocket BEFORE the insurance starts to pay. In some cases, such as an HMO, there IS no deductible and the cost is shared by both the patient and the insurance company from day 1. So the patient has a co-pay right away but it's less than the cost of service. If the patient reaches the maximum out of pocket, the insurance p ...[text shortened]... there is a lifetime max in which case the patient has no more insurance. Just sayin'.

    GRANNY.
    Best advise is to read your contract, and ask the agent. Of course asking the exchanges for truthful info is pretty hopeless.
  8. Standard member caissad4
    Child of the Novelty
    22 May '14 01:29
    Originally posted by Eladar
    How much are you going to be stuck for before the insurance that you pay for kicks in? In other words, what is your deductible?
    $4850 deductible.
  9. 22 May '14 02:31
    Originally posted by caissad4
    In my previous thread about the ACA I was unsuccessful in obtaining even a garbage health insurance policy. I was unable to complete the process due to numerous problems with the website and phone issues.
    But wait !!
    Today I received a packet from Humana telling me that I indeed have one of their truly garbage healthcare policies even though I NEVER compl ...[text shortened]... dly they didn't send me an actual insurance card.
    Big Brother must be watching out for me, lol.
    Look at the bright side, at least you are not a veteran.
  10. Standard member caissad4
    Child of the Novelty
    22 May '14 05:03
    Originally posted by whodey
    Look at the bright side, at least you are not a veteran.
    Uh, uh, I am a veteran. I just won't go to the VA.
  11. 23 May '14 01:00
    Originally posted by caissad4
    $4850 deductible.
    So you get to make payments to an insurance company so that after you rack up 5k in bills you can start getting covered.

    Isn't Obamacare special. I used to talk to my dad about getting high deductible insurance and his reply was that it is only for the rich. 5k isn't the much for them, but for the average guy 5k is nothing to sneeze at.

    5k is only if you get sick, you still get to make your monthly payments if you are sick or not. Why? So that if you get really sick the hospital that would have to give you service anyhow gets a bit of insurance money and the insurance company gets another sucker.
  12. 23 May '14 12:55
    Originally posted by caissad4
    Uh, uh, I am a veteran. I just won't go to the VA.
    What's wrong with the VA?
    I use it and think it's great.
  13. 23 May '14 13:08
    Originally posted by caissad4
    $4850 deductible.
    Have you spoken to an agent of your carrier (wasn't it Humana?). That should be much easier than dealing with the exchanges. I still say that you will have coverage subject to co-pays which accumulate to make up your $4850 deductible. Once the deductible is satisfied, everything is covered. This is the standard policy provisions of most health policies and has been for decades. Don't listen to me or anyone else here. Talk to the Humana representative and get the facts.
  14. 23 May '14 13:10
    Originally posted by Krod Mandoon
    What's wrong with the VA?
    I use it and think it's great.
    Most veterans I know say the same, as long as it is fairly routine stuff. Apparently there are still glitches in the system, especially involving intensive care, and life threatening conditions.
  15. 23 May '14 13:34 / 1 edit
    Originally posted by normbenign
    Most veterans I know say the same, as long as it is fairly routine stuff. Apparently there are still glitches in the system, especially involving intensive care, and life threatening conditions.
    Fortunately I've only had to deal with the yearly physicals, service is always great though, no waiting, I'm always called in at the appointment time, there's no charge for office visits, lab work or xrays,all prescriptions are 9 dollars a month regardless of what they cost on the outside, and if you do need to stay in the hospital or have surgery the cost is minimal. There's an emergency treatment office for walk-ins if you can't wait for an appointment, I did use it twice and was seen immediately.
    Before I started using the VA I've waited for hours in regular doctor offices and once in a hospital emergency ward I left after 2 hours without being seen, so my experience with the VA has been great compared to that.
    For many years I stayed away from the VA because I thought it was a place for bums and homeless winos, but the older I got the more expensive my health insurance became and the higher the deductible/copays became. The VA was like a breath of fresh air after I told my insurance company to bite me.