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Teach me about medical insurance

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Filed: Citizen (pnd) Country: India
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I never had to deal with medical insurance back in my country, and out here my husband has accidental insurance from his work but no medical insurance. We are looking for buying medical insurance and I am doing all the study I can, but to be honest I am not able to comprehend all the terms, so I need help.

Here are the questions I would like to ask.

--Plan type-- Network, HSA, PPO.....what exactly they are? which is more beneficial than the other and in what ways.

--When I read Deductible-- say it says $6000 deductible. I am comprehending it as-- we will have to pay up to $6000 of whatever the medical bill is every year..........am I right?

--Coinsurance-------Say it says 20%, I comprehend it as, after the yearly deductible of $6000 in our case, I will have to pay 20% of the left over bill for that year.....am I right?

--Copay--I am not sure what copay is, I see it says anywhere from $20 to $35, is it something to do with paying doctor's fee every time I go to doctor's office?

Thanks for answering any of the questions and if you can provide with any other input, its highly appreciated. Thanks again.

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Here's from our personal experience

Your husband has accidental insurance from work, this maybe just the additional disability coverage you are refering 2, whereas if he's injured he will get about 67% of his current salary, which put it to almost the same amount when you take out all the taxes and deductions.

PPO tend to be a little bit more expensive, the advantage with PPO you can pick any doctor that you want, there's a maximum amount that you pay yearly that's your deductible

HMO or other in Network group, they have a list of physicians and specialist on the network, where you can go to any of these doctors without having to pay extra. Usually you don't have much of a deductible as long as you stay in Network, even if you need a specialist most often you should be able to get one from the network

The most restricted one is Kaiser Permanente

If you are in a state that have kaiser, their premium is usually cheaper, but just like HMO in this case you HAVE TO GO to a Kaiser facility unless you have an emergency and can't reach a Kaiser hospital.

With HMO, Kaiser and even with PPO you have a Copay which is normally around $20 that you pay for your doctor visit, and also around $10 for each prescription.

I hope that help a bit, depending on your area and family need then you can pick the one that fits you the best.

Edited by Nikita2Charles

Gone but not Forgotten!

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Filed: Citizen (pnd) Country: India
Timeline

Thanks a lot Nikita2Charles, I will look into Kaiser.

Meanwhile I got a call from bluecross and with what the lady explained I think I got some idea of what to expect. She said yearly tests doesn't come under deductible and it is covered if I go for preventing check-ups. With the plans she mentioned, there were no co-pays to be paid and also had 100% insurance after the deductible.

For covering pregnancy with these plans I will have to be in the plan for 12 months before they would cover it. I forgot to ask her but I was thinking what if for now we take a simple plan without pregnancy coverage and can we transfer to the pregnancy coverage plan later down the road.

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Filed: Timeline
I never had to deal with medical insurance back in my country, and out here my husband has accidental insurance from his work but no medical insurance. We are looking for buying medical insurance and I am doing all the study I can, but to be honest I am not able to comprehend all the terms, so I need help.

Here are the questions I would like to ask.

--Plan type-- Network, HSA, PPO.....what exactly they are? which is more beneficial than the other and in what ways.

--When I read Deductible-- say it says $6000 deductible. I am comprehending it as-- we will have to pay up to $6000 of whatever the medical bill is every year..........am I right?

--Coinsurance-------Say it says 20%, I comprehend it as, after the yearly deductible of $6000 in our case, I will have to pay 20% of the left over bill for that year.....am I right?

--Copay--I am not sure what copay is, I see it says anywhere from $20 to $35, is it something to do with paying doctor's fee every time I go to doctor's office?

Thanks for answering any of the questions and if you can provide with any other input, its highly appreciated. Thanks again.

Copay is a fixed amount you pay for a visit or procedure. Typically $10 to $30. Insurance can cover the rest.

Coinsurance is when you have multiple insurance plans and how they share the costs. In such cases the costs are equally divided.

Deductible is how much much you have to pay for the year for services before the plan starts covering its amount.

PPO plans allow you to visit any doctor within their network of providers. Often these are independent businesses.

HMO requires you to pick one doctor as your primary doctor. They will your gatekeeper on when you need a specialist.

HMO will be more cost effective but PPO gives you more flexability.

HSA is an account which you can put money into from every paycheck pre tax. Then throughout the year it can be used to pay for a wide variety of medical expenses.

The best plans will come through large employers because they can negotiate good rates and you can work around preexisting condition issues.

If you are doing an individual plan and are young and healthy, a high deductible plan may be the better options because it helps you save of premiums assuming you have some emergency money saved for the deductible. But don't skimp on health insurance because health case is very expensive here and the number one cause of bankruptcy.

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