Health Insurance Deductible Explained

Hey it's Michael and I'm back with another video and in this video I'm going to talk about the health insurance deductible, explain how it works, where to find it, and what you need to know. And I'm going to talk about that right now. Okay like I said at the beginning of the video, I'm going to talk about the health insurance deductible and what you need to know about it so you don't get caught by surprise and how it works when you use your health insurance for any medical services you might need. You'll kind of know ahead of time you know what to expect and not just have sticker shock, oh my gosh I didn't know I was going to have to do that. Now I decided to do this video because we get our health insurance through my wife's employer and it's a new plan year so our deductible has reset so we got to satisfy it again. And not only that, they increased our deductible and they tie prescriptions drugs to the deductible which means we have to pay the deductible before our co-payment on drugs will kick in which is a change this year that not everybody realized that she worked with and she was talking to some of her co-workers and they were pretty upset about it because they had to pay all the prescriptions out of their own pocket and they're used to paying a co-pay. So I kind of knew this change was coming along because during enrollment time I had looked through all the plan information carefully and while I didn't like it I saw the prescription drugs were part were subject to the deductible. This is a good reason you know just as a side note here for face-to-face enrollments because you know if everybody self-enrolls it's hard to get all this information across so that people make sure that it sinks in if they just have to read it because most people don't read stuff. So just as a side note there that's my plug for face-to-face enrollments and why they're important to communicate these kind of things. So I want to talk about what a deductible is. First of all a deductible is the amount of money you got to pay out of your own pocket before your health insurance kicks in in certain situations. Now it's an important tool that insurance companies and the people that pay the plans set them up for self-insured and all that to keep costs down and to keep premiums down. You know because if you didn't have a deductible you know if your doctor said hey you know you don't really need to do this but you could do it just to be you know for peace of mind you know if you want to do it you know I'll sign off on a no big deal. Well then that raises costs for everybody and a lot of times we get some things that we don't need even though you know we didn't you know we didn't have to do that. So I know over the years a lot of times we've said oh we don't do we really need to do that and we've just opted not to do things because we just don't think it's you know worthwhile or necessary. Now the thing is that as these deductibles have increased it's it's allowed us to be choosier and save money for us and for the plans but the downside to it is that if somebody needs something and they don't have the money you're in a situation where you have to make a choice on whether you're going to get it or not if you don't have the money that that just pretty much makes the decision for you. So I'm kind of against these high deductible plans for those kind of things because you know people go without and it's silly to have no charge services for wellness and then make people suffer for medications that they need to take care of themselves and I know that people I've talked to who have had high deductibles they're like you know I just didn't get my insulin because I just couldn't afford it and you know it's just crazy how that stuff has to work. So when you get your health insurance information every year you want to look at one important tool and that's called the summary of benefits. Now the summary of benefits I just kind of made up kind of a sample one here so you can see what it looks like and you know it's not the actual summary benefits because I'm not sure that I'm allowed to show that. Now the first thing I do when I get it is after I understand what the premium is I look at my deductible and in our case you know the embedded deductible is $3,000 for single $6,000 for family for in-network. So while I'm thinking about it here you want to do everything you can in-network so you maximize the benefits of your plan because you know out-of-network is subject to some different rules and you know unless you absolutely have to you don't want to go into the out-of-network situation. Now let's just take a single situation for a minute the single deductible was $3,000 so if my wife was on only one on the plan she'd have to pay $3,000 out of her own pocket before the health insurance would kick in for certain things and so that's what would happen on a single family plan now or a single person plan. Now in our case we're a family so we have the family deductible of $6,000 and so there's three of us and so what that means is is that we got to determine what kind of deductible it is so we kind of understand what's going to happen after that. Now there's two types of deductibles there's an aggregate deductible and there is a embedded deductible. Now an aggregate deductible has sometimes been used in high deductible plans and what it says is is that like in this particular case if this was an aggregate deductible it means that in total all of us would have to pay $6,000 before the plan would pay anything for anything subject to the deductible and in our case though it's an embedded deductible and that's an advantage to us because what it says is is that if one person meets their deductible at $3,000 well then the health insurance is going to kick in even though we haven't met the family deductible yet and two of us would have to meet our deductible before the third person could just go and not have to and wouldn't be subject to the deductible and if you know if my wife spent $3,000 and I spent $1,500 and my son spent $1,500 well then that would total $6,000 and then anything above that the health insurance would kick in for all three of us. Now that's kind of how the deductible part works now there's some important things I want to point out here. I also look at the out-of-pocket limit each year so like you can see in our case for family it's $10,000 that's the most we're going to have to pay out of our own pocket in addition to the premium for the year so you know I know okay we're only going to have to pay that worst case scenario that's the most money I'll have to pay for the year so that's nice to know. Now there's a few things once that you know when you look at your summary benefits you can see here I've got like physician $50, preventative care NCS, inpatient facility services 0% and you can see I got prescription drugs it says medical deductible applies before co-payments and then I have some co-payments listed here okay now if you see just a number like this on your summary of benefits like in this case it says 50 bucks for the physician to go to the doctor and that's all it says well then that means that to go to the doctor in our plan we don't that's not subject to the deductible so all we're going to have to pay is the $50 co-payment even if we haven't met our deductible yet so it's better to see just a number there in that particular case because that tells us that that's not subject to the deductible. Now you'll see things like preventative care that say NCS and NCS stands for no charge service and that's like a mammogram you know for wellness screening and so in that case you could get that service done and you wouldn't have to pay the deductible either the health insurance plan would just pay it. Now what caught people this year oh actually the next thing is the inpatient facility services just as an example now there's a whole list of things on the summary benefits but I just picked one out and you can see in our case it says zero percent now if there's a percentage there what that means is is that that's your co-insurance amount once you satisfied your deductible now last year our co-insurance amount was 30 percent which means that even after we paid our full deductible then any service after that that had a percentage next to it like that we had to pay 30 percent of whatever that amount was. Now this year what's nice is is that our plan says zero percent so once we've satisfied the deductible then for any service subject to it then there's no additional cost which is great. So now where people got caught this year in our plan is is that they saw the co-payments for the drugs but they didn't realize that there was a little print there right above it that said medical deductible applies before co-payments on prescription drugs and that's what you got to pay attention to when you read your summary of benefits is to look for stuff like that because that tells me that okay you know for like in the case of you know my wife or son or I before I pay a co-payment for drugs I got to meet my deductible that means I might have to pay three thousand dollars of the drug cost on my own before my health insurance is going to kick in and just give me the co-payment. So when you look at your summary benefits the important thing to look at is you know the in-network benefits you want to stay in that work you want to look at your deductible whether it's embedded or aggregate and I always look at the out-of-pocket limit and then if there's just a dollar charge next to something that just means that it's not subject to the deductible neither are no charge services but anything you see a percentage next to is subject to the deductible and obviously if it tells you that it's subject to the deductible then it is too. So I hope that helps you understand how your health insurance deductible works you got any questions put them in the comments below and I'll be happy to try and help you understand your deductible and if you want to subscribe to keep track of my channel which I encourage you to do if you're on YouTube you can just hit that icon of my picture there and that'll help you subscribe to our channel. Obviously if you like the video hit the like button as well and you have any questions just let me know and I'll see you in the next video.