Understanding Your Deductible

The end of the year can bring more to celebrate than simply the holidays. By this time, you may have successfully met your health care deductible or out-of-pocket maximum. This allows you to partake in various health care services at a substantially lower amount and sometimes even at 100%. Read on for more details.

If you have a PPO, EPO or POS plan your health insurance deductible is used for larger items like procedures and surgeries. If you have an HSA plan everything goes towards the deductible. For example, let’s say you have a plan with a $4,000 deductible, 80% coinsurance and a max out of pocket of $6,000. This means that if you have covered your deductible you only pay 20% until you spend another $2,000 and have 100% benefits. Once $6,000 is spent in total - copays, deductible or coinsurance - then you have 100% coverage. “It is really important to know where you are at on your deductible,” says Alexandra Eidenberg, President and Founder of The Insurance People. “Right now, we are in the last quarter of the year and if you have already met your deductible and/or max out of pocket costs, it is a great chance to receive more care for the rest of the year at your coinsurance level or at 100%.”

Be strategic when it comes to your deductible! It doesn’t matter when your insurance started, your deductible always restarts with the calendar year. If you have already met your out-of-pocket for the year, get as many large expenses in as you can. If you have big costs coming up and have not met your deductible, Eidenberg recommends waiting until it resets next year. “If you have not yet reached your deductible and have not touched your deductible at all and you know you have bigger things to do, our recommendation is to wait until January because that way you can eat up your deductible and out of pocket costs in the new year,” she says. “You can spend all 12 months having coverage for the rest of the year instead of only the last month of this year.”

For more information call 773-697-8082 or email info@insuranceppl.com - we are happy to help!