In the past few years, there has been a lot going on with health insurance. In Washington State we gained the Washington Health Plan Finder, an easy way to find affordable health coverage. However, the affordability is hotly debated, with US Senator Maria Cantwell wanting to bring back a Basic Health Plan for the working poor. Many in Washington State forego health insurance because it is still too expensive and confusing, leaving them at risk for a mass of medical debt if they suffer from an injury. In this article I will discuss health insurance deductibles and maximum out-of-pocket expenses.
A deductible in health insurance is the amount the policy holder agrees to pay prior to the health insurance paying for treatment. Most people want low deductibles on their health insurance plans; however, these plans often come with higher premiums. A plan that has a $500.00 deductible will cost much more than a plan with a $6,000.00 deductible. Always know if the deductible is for per year or per treatment. You should always go with per year if given a choice since you want to pay down the deductible no matter the treatment. Otherwise you’ll be paying the same deductible amount for each separate treatment.
Why were health insurance deductibles even put in place? It comes down to two reasons; the first being the mitigation of irresponsible behavior. If someone knows they do not have to pay any money upfront it may be more likely the person takes risks that they otherwise would not take. The second reason deductibles exist is that it forces financial stability on the insurer’s part. Health insurance is unable to pay for every minor bump or bruise and so requiring the policy holder to pay lets the insurer deal with bigger claims that need more attention.
Coinsurance (also co-insurance) comes into play after the policy holder has met the health insurance deductible. Coinsurance is usually presented as a percentage for which both the insurer and the policy holder are responsible. When looking at health insurance plans, make sure to look at the coinsurance percentages. The higher initial number the better since the initial number is the percentage the health insurer is required to pay after deductible. Coinsurance for in-network providers is most often either 90-10, 80-20, or 70-30. If you see an out-of-network provider, coinsurance can dip as low as 50-50.
For example, a 90-10 coinsurance is exceptional because once the policy holder has met the deductible the insurer will be responsible for 90% of the medical debt whereas the policy holder is responsible for 10%. Let’s say a person has $3,000.00 in medical debt and has a deductible of $1,000.00 with coinsurance listed at 90-10.
From the above, you can see that the total amount the insured policy holder would have to spend is $1,200.00, which represents the deductible ($1,000.00) and the insured’s responsibility after coinsurance is calculated ($200.00).
I’ve Been Injured and my Health Insurance Is Not Paying
Your health insurance may not be paying your medical bills for multiple reasons. If you were injured on the job, L&I should pay instead of your health insurance. Likewise, if you were injured in a motor vehicle accident then Personal Injury Protection covers the cost of your medical treatment.
If you suffered a personal injury and your health insurance is giving you the runaround, give The Advocates a call. We’ve got experienced attorneys who deal with health insurance on a daily basis and know how to negotiate with insurance adjusters to make sure you get the most money from your settlement. Our consultations are always free so call us today!