Understanding California Health Plan Deductibles
First, the official definition:
Deductible
The amount
you must pay
for medical
services
each year
before your
insurance
begins paying.
The
deductible
is an
amount
you will
pay
first
before you get
help
from the
carrier.
Keep in
mind
that
with a
PPO
plan,
you will
get
discounted PPO
rates
which
can
lower
the
costs by
30%-60%
even
though
you have
a
deductible
to meet.
It's
very
important
to
always
stay
in-network
to keep
your
costs
down.
Exceptions
to
deductibles.
Most
traditional
plans on
the
market
allow
copays
for
office
visits
and
prescription
before
you meet
your
deductible.
For
example,
if there
is a $40 copay
for
office
visit,
you will
pay the
$40
right
away
rather
than
having
to pay
the full
doctor
visit
subject
to the
deductible.
Prescription coverage is frequently broken out separately from the main deductible. There may be a separate deductible from Brand name drugs. This means that with a $250 brand deductible and $30 brand copays, you would pay the first (resets each Jan 1st) $250 of your drug costs and then you would get $30 copays afterward. The brand RX deductibles on the California individual family market typically run from $250-$750 depending on the plan. On the California Small group market, the deductibles run from $0 to $250 on average.
Some
plans,
such as
the
popular
HSA
(Health
Savings
Account)
plans do
not
break
out
office
visit
and
prescription
from the
main
deductible.
The
deductible
are all
inclusive.
There
are a
few
other
plans on
the
market
which
include
the
office
and/or rx as
part of
the
deductible
so make
sure to
look at
the plan
detail
when
running
your
California
health
quote.
The
trade
off with
the HSA
plans is
that
they can
be much
less
expensive.
If you
are
saving
$500-$1000
annually
or more,
that
pays for
a lot of
office
visits
and
medication
cost.
Deductible
are
handled
in two
ways
when
multiple
family
members
are on
one
policy.
Except
for HSA
plans,
deductible
are
usually
per
person
when you
have
more
than one
family
member
on a
policy.
You will
typically
see a "2
member
max"
statement
around
the
deductible.
This
means
that if
two
people
in a
family
hit
their
deductible,
the
other
family
members
do not
need to.
This is
to
protect
against
a
catastrophic
health situation
where
every
family
member
had
large
bills in
one year
and the
resulting
out of
pocket
could be
10's of
thousands.
HSA's
or
Health
Savings
Account
plans on
the
other
hand are
cumulative
deductibles.
You
essentially
double
the
single
person
deductible
and the
entire
family
(2 or
more
people)
is
working
towards
one
family
deductible.
Depending
on the
situation,
this
works to
your
favor or
not.
If one
person
in a
family
has
large
bills,
he or
she has
a larger
deductible
to meet
than if
he/she
were on
an
individual
deductible
plan.
However,
if
multiple
members
have
bills,
it can
be work
to their
advantage.
Ultimately,
the
premium
savings
on an
annual
basis
should
more
than
compensate
for the
large
deductible
and that
has been
the
attraction
of HSA
plans.
The HSA
usually
has a
high
deductible
health
plan
as its
core.
Out
of
network
providers.
Keep
in mind
that the
discounted
PPO rate
for a
given
charge
is what
will be
applied
to a
deductible
if you
use out
of
network
providers.
For
example,
let's
say you
have a
$500
deductible.
If you
have a
$200
charge
for an
out of
network
provider,
and the
PPO
contracted
rate for
that
procedure
is $100,
the
carrier
will
typically only
apply
the $100
to your
deductible.
Try to
stay
in-network
with PPO
plans.
After
your
deductible
is met
in a
calendar
year,
with
most
plans, you then
start to
share
the
costs
with the
carrier
for
future
medical
charges
in the
form of
co-insurance
or copays
according
to the
benefits
of the
policy.
Other important concepts to help you understand your California health insurance quote are:
Co-pay
Co-insurance
max out
of
pocket
To
run your
instant
health
insurance:
California
Individual
Family
health
insurance
quote
California
Small
Group
health
insurance
quote
