How Much Deductible Must I Pay?
A deductible is an amount you pay before the Insurance Company starts paying. Health insurance plans will have different deductibles. Low deductible examples might be a “Gold” plan, with example deductibles of $500, $1,000, $2000, etc. An example of a “Silver” plan might have a higher deductible such as $4,000, $5,000, etc. A higher deductible would be seen in a “Bronze” plan at a deductible of about $8,700. But still, what is a deductible?
You Must Pay Your Deductible First
Think of it like getting to 1st base in a game of baseball. You start on home plate, and when you get your first medical bill, you’d start running towards 1st base. Beginning to pay towards meeting your deductible. You’ll be expected to pay the whole medical bill out of your own pocket until you’ve paid your deductible, or in other words, reaching 1st base using our analogy.
The very good news is, no matter what the deductible is, you will most likely pay what the insurance company has “negotiated” with the doctor or hospital, even before you’ve paid off your full deductible. As an example, if you have a $1,000 doctor bill because you visited a dermatologist for burning off a wart, the insurance company may have a negotiated a price of about $300 with that doctor, instead of having to pay the full $1000. That $300 you pay will apply to your deductible. So, if you have a $4000 deductible, now you’d have $3700 left of your deductible. Make sense?
Once you’ve paid all your deductible, you are standing on 1st base, using our baseball analogy. Until you’ve paid all $4000 using our deductible example, you’ve not reached 1st base yet. But once you’ve come out of pocket the full $4000, now you’ll begin to move towards 2nd base – “Co-Insurance”. During this time, co-insurance is where you and the insurance company split the medical bills. Some examples, 70/30, 80/20 or 60/40. Make sure to look at your health plan to see what your deductible and co-insurance are.
So, using our $4000 deductible scenario, and dermatology bill, if you have already paid the $4000 earlier in the year, and you are standing on 1st base and now heading for 2nd base, now you’ll pay a split with the insurance company. If your co-insurance was 30%, you’ll pay using our example of $300 (negotiated price of the $1000), you’d pay 30% of $300 which is $90. So, heading to 2nd base, called “co-insurance”, you’ll pay a split of an already discounted price. Usually, the insurance company will pay the larger amount (70%) and you’d pay the lesser amount.
Your next step is 3rd base or your “Out of Pocket Maximum”. This is the maximum YOU have to pay in a year, not the insurance company. Once you’ve paid the “out of pocket maximum”, there will be no additional charges, including cost of medications. The insurance company will pick you up on 3rd base and carry you to home plate. You are all done paying for the year. Please check the details of your plan for deductible, co-insurance and out of pocket maximum.
Getting Help with Nevada Insurance Enrollment
It is hard to budget for health expenses when you do not know what your cost-sharing responsibility will be. At Nevada Insurance Enrollment, our health insurance agents can help you review your policy or find reliable health coverage.
Recent Posts
Are Ambulance Rides Covered By Health Insurance?
If you have a qualified health plan (QHP) the answer is yes, ambulance rides are covered. A QHP is an insurance plan that is certified by Nevada Health Link in Nevada that covers “10 essential health care benefits” including emergency transportation. You may need to pay a deductible, co-payment, or co-insurance for your ambulance trip.
Does My Auto Insurance Policy Cover My Trailer?
You have an auto insurance policy that covers damage to your vehicle, but what if you regularly use your vehicle to pull your trailer? Does that trailer have the same coverage as your car or truck?
Sharing the Road: Motorcycles, Mopeds, Scooters and Bicycles
Motorcycles, mopeds, scooters and bicycles may account for a relatively small percentage of vehicles on the road, but they are consistently over-represented in fatal traffic accidents.
Search This Website
Most Popular Pages
By page visits (this month)
#1) Health Insurance Subsidy Chart
#2) Health Insurance
#3) Health Insurance WITH a Subsidy
#4) Insurance Blog
#5) Request a Quote
Top 5 Most Popular
By page visits (this month)
#1) Health Insurance Subsidy Chart
#2) Health Insurance
#3) Health Insurance WITH a Subsidy
#4) Insurance Blog Posts
#5) Request a Quote
Recent Posts
Automobile Rental Insurance When Renting A Car
Most drivers who have an auto insurance policy with collision and comprehensive coverage, decent health insurance, and homeowners or renters’ insurance can save their money by foregoing additional rental coverage.
The Tow Truck Damaged My Vehicle After An Accident
This also applies to damage that occurs after the accident. While you may consider the damage from the accident and the damage from the tow truck to be all one incident, your insurer will view it differently.
A Friend Wrecked My Car, What Happens Next?
If your friend was hit by an insured driver, the process will be simple enough. The at-fault driver will file a claim with their insurance company, who will pay to get your vehicle back to pre-accident condition. If the collision was bad enough to cause an injury, the at-fault driver’s auto insurance could also cover medical bills, lost wages and any other expenses associated with the accident.
Why Every Household Driver Should Be On Your Auto Insurance Policy
Generally speaking, anyone who lives with you that has a drivers license – whether they’re a member of your family or not – is considered by your insurer to be a member of your household. College students away from home without a vehicle aren’t required to be on a policy, and could be a “permissive” driver.