Why healthcare insurance has high deductibles

high deductibles
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For those of you shopping for new insurance, you probably want the most affordable plan out there. Even if you find an inexpensive plan, there’s a catch. Plans that are less expensive month-to-month have high deductibles as a trade off. That means if you actually need a doctor, medication or hospitalization, you’ll be paying a lot out of your own pocket before your insurance kicks in. But it’s even more confusing than that!


How the insurance companies get you with high deductibles

If you qualify for a plan on the health insurance exchanges you may actually get affordable health insurance with the government subsidies. However, if you don’t qualify for a plan on the exchanges, you’ll pay the true price of health insurance, which is way more expensive. That means that even the most affordable plans are still expensive month to month. But what’s crazy is that even the most affordable plan, whether it’s on the exchange (ie a subsidy by the government) or not subsidized, the deductible will still be high. As in $5000 to $6000 high. So whether you’re on the Healthcare Exchanges or not, you’re paying big time.


Let’s say you need medication, see a specialist physician (cardiologist, neurologist, etc) or need an X-ray. You’ll be paying for that if you haven’t already met your deductible for the year. And your monthly premiums don’t count towards the deductible. What’s crazy is that if you go to a hospital to get your X-ray, there’s a pre-arranged rate with your insurance company – the negotiated rate. So even if your insurance isn’t paying for the X-ray, they’ve made a deal with the hospital to determine how much you’ll have to pay for it. Let’s assume the prearranged rate for a chest X-ray is $500. If you went to an outpatient X-ray center that had no deal with your insurance company, they might only charge $50!


Why even get insurance?

So you start to wonder, why am I paying a monthly premium to ABC insurance company and the best deal they can get me at the in-network hospital is $500? You may go on to say, “I could forego insurance and just go to the least expensive place I can find.” That’s all true. However, you still want some kind of insurance for a catastrophic event. The problem is that with the Affordable Care Act, even catastrophic insurance may be expensive.


The good news is that if you recognize up front that you’re paying for outpatient services no matter what, you’re better off paying for it out of pocket. Because if you try to go through insurance, the insurance won’t pay for it but you still get stuck with the “negotiated rate.” As we pointed previously, that’s more expensive than the cash-pay, non-insurance rate. But don’t fret. Whatever you end up paying for services, wherever you get those services, can still count towards your deductible. Even if you go out of network and pay out of pocket for some service, just submit your receipt to your insurance company so it can count towards your deductible.


Looking for affordable healthcare before your deductible is met? Click here for a service, the price and a doctor near you.


Click here for the original blog post written by Dr. Jonathan Kaplan for BuildMyBod.


“Dr. Kaplan is a true professional. He gave me extremely helpful and direct honest advice…I strongly recommend him.”– David S.

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