Whats's your health insurance annual deductible, & annual out of pocket max?

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nakedfrog

No Lifer
Apr 3, 2001
58,055
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But we get to choose which shitty health plan we want, and we get to choose our doctor! Kinda, sorta, maybe. And we don't have long waits for care... well, except we have that too.

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bba-tcg

Senior member
Apr 8, 2010
569
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computerguyonline.net
VA - no OOP, no yearly. I do have a copay for meds. Zero monthly.

Edit: Oddly, they won't pay for emergency ambulance rides unless you have a high disability that's service connected. I think it's 70% or more.
 
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fralexandr

Platinum Member
Apr 26, 2007
2,243
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www.flickr.com
Blue Shield Lite POS (HMO + PPO) Plan

Deductible:
$400/person; $800/family

Annual Out Of Pocket Max:
HMO

$1,500/person; $3,000/family

In-Network
After deductible: $4,000/person; $8,000/family

Out-of-Network
After deductible: $6,000/person; $12,000/family

-----
I can also pick Kaiser HMO, but it costs ~$100 more per month
No Deductible

Annual Out-of-Pocket Maximum
$1,500/person
$3,000/family
 
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Chapbass

Diamond Member
May 31, 2004
3,143
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91
I'll throw my data in:

Deductible:
400/individual, 800/family

PPO
In-network OOP max: 2,000 individual, 5,000 family
Out of network OOP: 5,000 Individual, 10,000 family

co-pays vary between 0 and 30 (except for 250 for ER)

Monthly Premium: 110 for individual, 420 for family.
 
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JimKiler

Diamond Member
Oct 10, 2002
3,558
205
106
I am on a high deductible health plan, HDHP. Until this year we had 3 HDHP options. I finally figured out the middle option was stupid because you paid more in payroll deductions for a $200 difference in coverage compared to the one with the highest deductible. HR must have figured it out as well since it is no longer option, we have 2 HDHP options now.
 

biostud

Lifer
Feb 27, 2003
18,193
4,674
136
But we get to choose which shitty health plan we want, and we get to choose our doctor! Kinda, sorta, maybe. And we don't have long waits for care... well, except we have that too.

giphy.gif
Just imagine if you could cut out the expenses for insurance companies and actually do health care. :p
 

nakedfrog

No Lifer
Apr 3, 2001
58,055
12,245
136
Just imagine if you could cut out the expenses for insurance companies and actually do health care. :p
It was fascinating how much my prior insurance company was willing to pay in order to be able to deny me care. I had a regularly scheduled procedure, explicitly covered in my plan documentation, and their business processes were set up such that it was ALWAYS declined the first time it was submitted. They literally paid someone to watch my account for these, and that person then resubmitted them, upon which they would be approved. I mean, obviously I had to have back and forth with them to get this going, and after a few months of it I told my rep "this is, for lack of a better word, stupid. Isn't there some way better way to do this?" and was informed this is simply how the process works. But naturally not everyone is going to be willing to wade through the bullshit to get this accomplished, so they win out profit-wise there.
It's so fucking irritating 😣
 

biostud

Lifer
Feb 27, 2003
18,193
4,674
136
It was fascinating how much my prior insurance company was willing to pay in order to be able to deny me care. I had a regularly scheduled procedure, explicitly covered in my plan documentation, and their business processes were set up such that it was ALWAYS declined the first time it was submitted. They literally paid someone to watch my account for these, and that person then resubmitted them, upon which they would be approved. I mean, obviously I had to have back and forth with them to get this going, and after a few months of it I told my rep "this is, for lack of a better word, stupid. Isn't there some way better way to do this?" and was informed this is simply how the process works. But naturally not everyone is going to be willing to wade through the bullshit to get this accomplished, so they win out profit-wise there.
It's so fucking irritating 😣
I heard an interview with the CEO of Novo, and he said that American system was absolutely worst in term of pricing your products, because it is neither a free market or a government body. Those who skimmed the milk was the middlemen in this very complicated insurance system.
 

JimKiler

Diamond Member
Oct 10, 2002
3,558
205
106
Just imagine if you could cut out the expenses for insurance companies and actually do health care. :p
Supposedly bureaucracy accounts for 30% of the healthcare bill, between providers, insurance, and all those middle men.
 

Fenixgoon

Lifer
Jun 30, 2003
31,493
9,824
136
HDHP/HSA

premium is $100/mo I think?
copay is usually 20% i think?
deductible is $1500?
max OOP is $2500?

big thing is my medication got fully covered last year. normally that was $1500 for the first dose ($5 after that) but now it's $5 every time. my medication bills out for $130k/year o_O
 
Dec 10, 2005
23,990
6,793
136
I cover my spouse and myself through one my employer's options. Deductible is $3k, OOP max is $8k; they also throw $500/year into an HSA for us and we also contribute to it. Our yearly healthcare expenses are low: 1-2 maintenance meds filled via the plan's online pharmacy (which thanks to some IRS rules, allows pre-deductible cost sharing) and maybe 1-2 office visits/year outside of annual physicals, which are covered pre-deductible.

The other options we had available to us:
  • Move to a higher tier plan with more upfront cost-sharing: the additional premiums and loss of the HSA meant we would be spending more than we'd be getting in benefits
  • Have my spouse take her insurance through her medical school instead: the premium for that was absurd; it had tons of cost sharing upfront, but in aggregate, the cost was way more than the option we ended up selecting
To add, since people were interested in premiums and how that plays in to overall costs:
$540/mo - largely driven by my wife being on the plan. If it was just myself, it would be around $130/mo, since my company only heavily subsidizes the employee.

However, looking at my W2, the employer portion of the health insurance is an eye-popping $20k (box 12/DD) for 2022.
 

IronWing

No Lifer
Jul 20, 2001
68,854
26,646
136
Deductible is $3,000 for self plus one plan but there is an employer premium pass through to an HSA that knocks the effective deductible down to $1,200. Out of pocket max is $10,000. We blow through the deductible every year thanks to corrupt U.S. patent laws.
Total premium is just over $15.5K/year.
 

MtnMan

Diamond Member
Jul 27, 2004
8,722
7,828
136
But we get to choose which shitty health plan we want, and we get to choose our doctor! Kinda, sorta, maybe. And we don't have long waits for care... well, except we have that too.
Saw a specialist today, was referral was made exactly 2 months ago. Quick health care is just another All American Red White & Blue republican Lie.
 

JEDI

Lifer
Sep 25, 2001
30,160
3,300
126
We just got a letter from United Healthcare, the health insurance that our family has had since January 1, when they switched over from Anthem. The letter said something about annual maximum in network deductible, so I went online to find some examples of that, to understand it better. I found this example:

Deductible vs out-of-pocket-max example​

Let’s say you have a health insurance plan with a deductible of $1,000 and an out-of-pocket maximum of $4,300.

So I looked down at our insurance, and I see that we have a family annual in network family deductible of $5,000. It also shows that we have a Maximum in network Out of Pocket Maximum of $6,850.
The letter also showed that as of March 31, we are about $4,000 of the way towards meeting the $5k annual deductible, and $6,850 out of pocket annual maximum.

WOW!!! These numbers are definitely higher than they were last year under Anthem, and they have really jumped up a LOT over the past 8 or 9 years. It was about 9 years ago when my wife's workplace took away the choice of
traditional health insurance, where you would just have insurance, and you would pay a copay, something like 10% each time you went in for medical treatment. They switched over to high deductible, which the first year had something like
$3,000 that we had to pay up front, maximum. It has grown every year.

Anyway, I found myself thinking how unlikely the example is, but then realized that I have absolutely no idea what typical numbers are for a family. Is the $1,000 annual deductible and $4,300 annual out of pocket max example
pretty common for a family, or is out situation more common?

All I know for sure is that we used to be able to put money into our IRA, but now that we pay the first $5K or more of health care costs out of pocket each year, we don't have much left to sock away for retirement. Not sure what folks are going to do if it keeps going this direction. Let's say, in 15 years - how will the typical family deal with having to pay the first $15,000 of heatl care costs up front out of pocket each year???
i have anthem.
It's just me and it's $7.5k/yr in premiums.
$50 deductible, 5% co-pay. (But 50% co-pay for emergency room.)
no clue what my max out of pocket is.

It's great insurance but I probably should switch to a high deductible plan next year.
Last year's summary says Anthem paid out around $4k to various doctors so i didnt get my money's worth from my premiums.
 

sonoma1993

Diamond Member
May 31, 2004
3,409
19
81
I have Unified Group Services insurance through my employer
premiums for the wife and I is $3200/year
In network deductible is $100
In network out of pocket is $1000
Out of network deductible is $100
Out of network out of pocket is $1000
 

biostud

Lifer
Feb 27, 2003
18,193
4,674
136
As far as I know the healthcare "tax" is around 8% of your income, and after deductibles, that would be ~$6000 for me last year, which is for universal health care except dentist (children are paid for until 18). Medicine is increasingling subsided up to $600/year, where 85% is then paid over the taxes.
 
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GunsMadeAmericaFree

Golden Member
Jan 23, 2007
1,240
290
136
I have a $6k family deductible and $13.8k family out of pocket limit :confused_old:
If you have an HDHP you could be putting money into an HSA.
I actually do put money into an HSA each year, but I leave it in there for health care costs in retirement, rather than dip into it now. That makes it kind of like an IRA. It makes things a bit harder financially for the first half of the year or so, until we hit our maximum out of pocket each year. However, putting the money into the HSA gives us a deduction on our taxes, so it is worth it. Eventually, I should find an HSA that lets us put the $ into index funds.
 
Dec 10, 2005
23,990
6,793
136
I actually do put money into an HSA each year, but I leave it in there for health care costs in retirement, rather than dip into it now. That makes it kind of like an IRA. It makes things a bit harder financially for the first half of the year or so, until we hit our maximum out of pocket each year. However, putting the money into the HSA gives us a deduction on our taxes, so it is worth it. Eventually, I should find an HSA that lets us put the $ into index funds.
Not hard to find cheap or free HSAs that let you invest in cheap index funds. It seems that most HSAs have this option nowadays.

Fidelity has a fee-free HSA, Old National Bank has an HSA that is fairly cheap if you invest and has access to some Vanguard funds.

However, the big thing for HSAs is if you can contribute directly from your paycheck into a work-sponsored HSA: if this option is open to you, you also get to save on SS taxes.