Insurance Deductible

Insurance deductible is paid and it is done-you pay it for one thing or another -what is the difference if it is for a mask or an MD visit. Even if I pay the deductible for a CPAP this year and the rental period happens to end in the next year. It isn't really that I pay two deductibles on the CPAP-it is just some amount of cash I'm going to be putting out. If a doctor's bill gets to the insurance company first I pay the doc with the deductible-and the DME gets paid by insurance. If the DME gets there first my deductible is paid out to the DME and insurance pays the doc. Either way the deductible is the same.

I disagree. I for one never come anywhere close to my annual deductable except for this one year with the sleep study. I seriously doubt that I will come anywhere close next year. SO given that, for me a deductable IS money out of my own pocket. It is money I would have paid NOONE so it all depends on your circumstances.

Your "Deductable" is paid annually... every year you have a new one. What you may be confusing it with is a "Copay" which is paid per occurance for each instance of each particular service or mechandise purchase or rental charge that is subject to a copay.

In many policies items that are subject to a copay do not apply to your deductable. So, for example, if you have a $30 office visit copay and see your doc 10 times in a year you paid $300 out-of pocket but have not satisfied one dollar of your deductable.

Thank you wading for adding this. I almost said this too but had to run to get my kids to school! This is the reason I almost never meet my deductable. Most of my small medical expenses do not go towards my annual deducatable.

To take it a step further. If I haven't met my deductable, the full inflated cost of a mask from a B and M DME is out of my pocket. If I have met my annual deducatable then I only foot the bill for the copay portion of the mask as my insurance company will pick up the rest.

It follows that if I buy a $709 CPAP in November out of pocket I pay $709. If I buy an $1875 cpap (reasonable DME price) in Nov and I haven't met my deductable, I pay my deducatable or whatever portion is outstanding then just a copay. (my full deductable is $618) So for the sake of arguement let's say that there is $400 left to satisfy my deductable for 2006 and the DME is billing $125 per month on the CPAP with the balance due upon conversion from rental to purchase.

Ok that is two months where I pay $125 per month (the full bill) = $250 because I haven't satisfied my deductable and won't without CPAP purchase or rental.

(Still haven't met my deductable by the way but the year is over anyway).

January 2007 -- my deductable starts over. I am paying $125 out of my own pocket until I meet the deductable. I will assume for the sake of arguement that I would have had medical expenses anyway that would satisfy $300 of deductable anyway in 2007 (so I can't count that since I would have paid that to someone anyway), so I would pay out of pocket until I reached $418 (my $618 deductable minus the $300 I would have used anyway). Then insurance kicks in. Now I have paid $668 for this CPAP ($250 from last year and $418 for this year up to meeting the deductable) and insurance has paid NOTHING. Now there is $1207 (of the original $1875) left to be paid over the year 2007. I only pay my copay (since I have met my deductable or will have, with those other $300 of medical expenses anyway) so 20% of $1207 is $240. Add that together $240+ $668 and you have a $908 out of pocket CPAP machine.

That $908 is what must be compared to a cash purchase $709 for Remstar AUTO or less for Pro2 or whatever for another machine or brand....

Now the fun part of all this is seeing into the future. Some medical expenses you can predict. You have certain procedures scheduled that you know will count against your deductable, for example a colonoscopy possibly if you are on a preventative schedule with that. But how do you predict if you break you leg and will satisfy you deductable in one day? Of course one doesn't know for sure, but I for one have my own medical history and I use this to make intelligent guesses.


To go back to the discussion of 2 seperate annual deductables....
If I had bought that CPAP in Jan then I would have saved $200 off that $908 bill as the two $125 payments would have only cost me $25 each so by delaying the expense I would have a $708 CPAP. In reality, most people buying CPAP are getting it in the year of the sleep study which for a lot of us finishes off the annual deductable in one swoop. So in that case the CPAP is 20% of $1875 = $275.

You can't just say you pay your deductable to "SOMEONE" anyway. Doesn't work like that.

Of course your numbers will vary based on copay % if any, deductable amount, other medical expenses, cost of CPAP from your DME etc.....

snoregirl wrote:Thank you wading for adding this. I almost said this too but had to run to get my kids to school! This is the reason I almost never meet my deductable. Most of my small medical expenses do not go towards my annual deducatable.

My wife currently works for a small company with a bad insurance plan. There is a high deductable and high copays for almost every service. The copay for Chiropractic visits is more than the Doc charges. LOL! Needless to say we get little or no benefit from her plan....what a racket!!!

I fully understand. My insurance has an individual deductable ($618 for each of us) and a family deductable which is equal to 3 of you meeting your individual deductables.

So we would NEVER meet the family one other than having a bad family car crash, or some amazing coincidence where we all had some big medical issue that went against deductable. Even in a year (actually happened) where we had a broken leg and a colonoscopy we didn't meet the family deductable.

Some folks are really lucky to have 100% copays and low deductables. It is really hard to say in this day and age if they are paying for it in other ways though like through payroll deduction or they are just lucky with what their employer provides.

All one can say is each individual has to do their own financial analysis to see what is best and we all can use this forum to help others make good financial choices for their own particular situations. Everyone needs to understand their own policy and ask the right questions so they can make the right choice, which will not be the same for others.

Gross generalizations are dangerous. That is my main point.

You are right-I assumed that with the medical followup and CPAP equipment to buy most people would meet their deductible easily and quickly and - forgot some people have high deductibles and are younger and healthier than I. I had a $250 deductible for insurance-I met that the first week of January.
When I took early retirement I had a choice of taking 50% of my retirement immediately or waiting 10 years and getting 100%. But if I waited I didn't get to take my insurance with me. I opted to take the 50% and the insurance. Glad I did-At 65 I get back more than I put in in premiums, co-pays, and drugs. I track it so I can make a decision each open season about continuing or switching to another plan.
Good health to you and may you never have to meet your deductible.

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Please do not blame your cpap supplier. They only do what your insurance tells them to do. You really need to know your insurance plan inside and out. Weigh the cost of the policy versus the annual deductible. In some cases you pay more in premiums for a low deductible than you would for the entire year if you paid the higher deductible.

Example - I have several options thru my employer

Option 1 $250 deductible cost for family plan is $375/month total of $4500 per year.

Option 2 is $2500 deductible cost for family plan is $22.61/month total of $271 per year.

If I take the higher deductible and budget my expenses based on history I can put $2500 into a pre-tax flexible medical account which I can use for all medical expenses including copays, over the counter medicine like motirin or alka seltzer etc. in addition to eyecare and dental needs and still pocket an additional savings of at least $1500 per year in lower monthly premiums.

Take the time to do the math! If you are concerned about pricing pay privately for your care and negotiate the prices upfront and then you send the bill to your insurance.

insuranceguru wrote:Please do not blame your cpap supplier. They only do what your insurance tells them to do. You really need to know your insurance plan inside and out. Weigh the cost of the policy versus the annual deductible. In some cases you pay more in premiums for a low deductible than you would for the entire year if you paid the higher deductible.

Example - I have several options thru my employer

Option 1 $250 deductible cost for family plan is $375/month total of $4500 per year.

Option 2 is $2500 deductible cost for family plan is $22.61/month total of $271 per year.

If I take the higher deductible and budget my expenses based on history I can put $2500 into a pre-tax flexible medical account which I can use for all medical expenses including copays, over the counter medicine like motirin or alka seltzer etc. in addition to eyecare and dental needs and still pocket an additional savings of at least $1500 per year in lower monthly premiums.

Take the time to do the math! If you are concerned about pricing pay privately for your care and negotiate the prices upfront and then you send the bill to your insurance.

Great advice....unless you are lucky enough to have a policy that pays for everything (which are few and far between these days) you have to make sure you understand exactly how your policy will pay. Keep in mind that it may be likely that you will pay LESS if you buy online and pay out-of-pocket. Insurance companies have a magical way of writing their policies to look as though they "cover" things when ultimately they actually may pay very little.

Insurance can get confusing- I remember I had a plan that paid 80% on brand name prescriptions & a $5 copay on generics. Unless of course, I had meet my out of pocket maximum, then it paid 100% for brand name & I still had to pay $5 copay for generics. Since I kept having to have knee surgeries (4 in 2 years), I learned to asked doctors to write 'dispense as written' as soon as I hit the my out of pocket maximum.

Durable medical can get even more confusing- another policy I had through the university, while in grad school, had a $100 limit per yer on DME- not dedeductable, but total for the year. What can you get for DME that is less $100? My DME was great though, they found a loop hole & got some of the stuff I needed paid under the home health care benefit part of the policy and wrote off most of the rest.

krousseau wrote:You are right-I assumed that with the medical followup and CPAP equipment to buy most people would meet their deductible easily and quickly and - forgot some people have high deductibles and are younger and healthier than I. I had a $250 deductible for insurance-I met that the first week of January.

Ditto.. I have a $300 deductible (with a total out of pocket maximum of $1500) and met that in January due to a broken bone in my foot. I also have a $0 co-pay for office visits. My chiropractor monthly bills (I go once a once for adjustments) are about $6 after insurance. I think I pay about $28 a month for my insurance premium but this is for single coverage. If I went for the "family plan", it would cost me close to $800 a month. That's just insane. For a lot of the office people who work where I do, this is practically an entire paycheck.

I'm very thankfull that we also have the FlexPlan through my job too. I had flexed $700 for this year and used that up in January as well. Why? Because the foot doctor thought I had BCBS of North Dakota and set me up with orthotics. BCBS of ND pays for one set of orthotics a year. BCBS of MN does not cover this unless you have diabetes. Yeah. I think that alone was about $700. (The orthotics are nice, but not THAT nice.)

Anyhow... I appreciate the fact that I have good insurance at a decent price. (I could have it for free but the deductible is higher.) DH's insurance is similar to mine (BCBS of ND) but he pays a $20 deductible. I don't think he's ever met his deductible. Although maybe he did in 2004 when he had his motorcycle accident. The one block drive to the hospital in an ambulance was over $1000. (Thank goodness this wasn't the Harley he was on.)

Kimberly

PS. Insurance gives me a headache.

That is a really good example of how it is really a pot shot in picking which insurance option to get.

That catastrophic accident (motorcycle accident referenced above) that no one can plan for.

All you can do is make your best guess and hope you are right. By the way our open enrollement period is going on right now. And that is just what I am doing....

WOW just got my open season packet too-my insurance went down 97 cents-better read the fine print-the deductible probably went up to $500.