Health plans can seem complicated. It helps to know what questions to ask and where to find the information you need.
\nTake deductibles, for example. They\u2019re important to your pocketbook, but do you know how they work? To get you started, here are answers to some common questions we get from our members.<\/p>\n
Q: What is a deductible?
\nA: A deductible is the amount you pay for health care services each year before your health plan starts to pay. For example, if you have a $1,500 deductible, you pay the first $1,500 of the services you need.<\/p>\n
Depending on your plan, you may also need to meet this in-network deductible before you pay for covered prescription drugs. This means you will pay the prescription\u2019s full cost upfront until the deductible is met. Then you will pay your copay or coinsurance amount until you meet your yearly out-of-pocket maximum. But some plans do not have a deductible. And some types of medicines may be available at a lower cost (as little as $0), even if the deductible has not been met first.<\/p>\n
Q: What happens after I meet the deductible?
\nA: Once you\u2019ve met your deductible, you usually pay only a copay and\/or coinsurance for covered services. Coinsurance is when your plan pays a large percentage of the cost of care and you pay the rest. For example, if your coinsurance is 80\/20, you\u2019ll only pay 20 percent of the costs when you need care. Your health plan pays the rest.<\/p>\n
Q: You said a deductible is the amount you pay each year. Does the deductible reset each year?
\nA: Yes. Since your deductible resets each plan year, it\u2019s a good idea to keep an eye on the figures. If you\u2019ve met your deductible for the year or are close to meeting it, you may want to squeeze in some other tests or procedures before your plan year ends to lower your out-of-pocket costs.<\/p>\n
Q: Is a health insurance deductible different from other types of deductibles?
\nA: Unlike auto, renters or homeowner insurance where you don\u2019t get services until you pay your deductible, many health plans cover the cost of some benefits before you meet the deductible. For example, your plan may cover the cost of annual physicals and many preventive health screenings before the deductible is met.<\/p>\n
Q: My plan information says I have a family deductible, too. What does that mean?
\nA: If your plan covers your family, there will probably be a deductible for each person and a separate family deductible. As soon as the family deductible is met, your plan starts paying at the coinsurance amount for everyone\u2019s care. That\u2019s the case even if some family members haven\u2019t met their individual deductible.<\/p>\n
Here\u2019s a good example of how this works:
\nYour family gets in a car accident. You all need to get checked at the hospital for injuries. If each person had to meet an individual deductible, you would pay all the deductible amounts before your coinsurance started paying.<\/p>\n
With a family deductible, once you met that one family deductible amount, no other individual deductibles are needed. After the family deductible is met, you\u2019ll only pay your copay and\/or coinsurance amount for services for each family member.<\/p>\n
Some plans, like a health spending account (HSA) may only have a family deductible, so your member ID card will only list one deductible. Check your benefit details if you aren\u2019t sure.<\/p>\n
Q: Do all health care services apply to my deductible until it\u2019s met?
\nA: Not always. Some plans fully cover preventive services, which means you don\u2019t pay anything at the time you get them. Because you don\u2019t have an out-of-pocket charge, those services won\u2019t count toward meeting your deductible.<\/p>\n
If you receive care that isn\u2019t covered by your health plan, it often won\u2019t count toward your deductible. This might include such things as cosmetic procedures or seeing a provider who isn\u2019t in your health plan\u2019s network.<\/p>\n
Q: What are the pros and cons of a high or low deductible?
\nA: In most cases, the higher a plan\u2019s deductible, the lower the monthly premium. If you\u2019re willing to pay more when you need care, you can choose a higher deductible to reduce the amount you pay each month.<\/p>\n
The lower a plan\u2019s deductible, the higher the premium. You\u2019ll pay more each month, but your plan will start sharing the costs sooner because you\u2019ll reach your deductible faster.<\/p>\n
Some people who don\u2019t often need medical care would rather have a smaller premium and pay more up front for care as they go. But it can mean taking a chance that you might end up paying a big medical bill if you have an unexpected illness or injury.<\/p>\n
Other people like knowing that when they need their insurance, they won\u2019t have to come up with a large sum of money before their plan starts helping with the cost. They\u2019d rather have a higher premium, but a lower deductible. It makes costs more predictable.<\/p>\n
Q: If I pay so much out of pocket before my insurance kicks in, why should I have coverage?
\nA: Health coverage can lower your costs even when you must pay out of pocket to meet your deductible. Insurance companies negotiate their rates with providers, and you\u2019ll pay that discounted rate. Without that discount, people often pay twice as much \u2014 or more \u2014 for care.<\/p>\n
For details about your deductible, log in to Blue Access for MembersSM<\/sup> (BAMSM<\/sup>)<\/a>. You\u2019ll see your deductible amount in the Coverage section. You can see how much of your deductible you\u2019ve met to date in the Spending section.<\/p>\n To find more information about insurance terms, check out the BCBSTX online glossary<\/a>.<\/p>\n