Comments on: Health Insurance: Understanding Your Deductible, Co-pay, & Out-of-Pocket Maximum

By: JJ

JJ — Sat, 10 Dec 2011 19:33:50 +0000

This helped a bunch after a recent couple big medical visits. Thanks!

By: Roy Thurman

Roy Thurman — Thu, 08 Dec 2011 02:19:08 +0000

I draw 596.00 a mo. on disability . My wife works at a plant and makes bout 26,000 a yr. My question is why do they take out almost 100.00 per mo. from my check when my wifes insurance takes care of 80% of it . seems like double dipping

By: Tanya

Tanya — Mon, 28 Nov 2011 18:40:39 +0000

Our new insurance has no annual deductible. We have a $5000 yearly out of pocket maximum. How does this work?

By: Cheryl

Cheryl — Fri, 28 Oct 2011 13:32:12 +0000

Hire a medical billing advocate. Most do not charge unless they save you money. Check out Medical Billing Advocates of America.

By: gayla

gayla — Fri, 30 Sep 2011 14:15:37 +0000

I am double insured my employer which has a 20.00 co-pay for office visits and my husbands insurance which has a 30.00 co-pay I am not sure why I would have to pay a co payment at all if my insurance pays all but the 20.00 why would the secondary not pay the difference?

By: becky

becky — Thu, 22 Sep 2011 20:41:13 +0000

Your out of pocket max is the max amount you are required to pay per year. That includes deductibles, copays, and any co-insurance. Once you reach your out of pocket max your insurance pays 100% up to their maximum yearly payable amount of $100,000. If your insurance reaches that $100,000 max, anything over that is your responsibility, meaning you have exhausted your insurance benefits for the year. This is the case each year. Just make sure to verify that the $100,000 is a yearly maximum benefit payable and not a lifetime maximum.

By: Rishi

Rishi — Wed, 21 Sep 2011 21:03:54 +0000

I am an International Student with a Pre existing condition called THALASSEMIA. I need Blood Transfusions every 21 days no matter what. I am on a Aetna Students plan which pays 80% of my bills & t20% i am expected to pay. The 20% amounts to USD 1200 every month approximately!!
My Max out of pocket is USD 5000 and the Maximum is USD 100,000!
I Would reach my Max out of pocket VERY quickly. What will happen after that??
Will the insurance company pay 100% of my medical bills then? Is the Maximum limit of 100,000 USD calculated at actuals after each bill (eg if my medical bill after i have exhausted my out of pocket maximum comes to 10,000 USD. Then the Insurance company will pay for 10 more medical bills OR will they consider 20% amount ie. USD 1200 which I was paying & keep paying till they reach USD 100,000???)
PLEASEE clarify this as I am tired of asking my insurance company over teh phoen & they fail to understand.

By: Bradley

Bradley — Wed, 21 Sep 2011 18:31:51 +0000

Once the OOPM is met, does insurance cover all expenses, including prescriptions? That is the only part I am unclear about.

By: Doc

Doc — Wed, 17 Aug 2011 04:23:41 +0000

Yes, you’re right. Forget all these ignoramuses that don’t understand the complete ins and outs of medical/legal terminology! And trailer trash, well they don’t count as humans do they? Even if tough luck got them their discriminatory status you label them with. Heck, it should just be all good people like you in this world and everything would be OK. The sad thing is that profit is placed as a motive to maintain basic health care, which if healthcare was just an option for decent health, kind of like an option for leather seats, that would be reasonable.
In a society that is no longer agrarian with a widely dispersed population, but one that is now being weaned on petroleum byproducts and empty calories we have forced a health dilemma upon society that necessitates a basic level of vaccinations and healthcare; to deny people that in the name of profits is unjust.
I do wish you all good health, good healthcare and fair and reasonable healthcare coverage.

By: JJ

JJ — Mon, 18 Jul 2011 19:50:58 +0000

OK, in exchange for paying about $27,000 per year out-of-pocket, Roger gets about $135,000 in pharmacy benefits, plus other benefits. THAT does not sound like “greed” on behalf of the insurance company. It is a very tough situation indeed, but at least he’s not trying to pay forr it ALL himself. Oh, and Kelly- instead of spending your tax return on something frivolous, and insisting it’s your right to have cable tv, private Internet access, smartphones, vacations, and $5 coffees, you should have 6-8 months’ pay saved up to help pay for emergencies, like unemployment or a health condition. That’s where middle-class Americans get that kind of money.