Friday, January 4, 2013

What's the difference between deductible and total out of pocket expense when referring to health plans?

Q. I have no experience with health plans. Please help me understand!

A. The deductible is the minimum you pay, the total out of pocket is te maximum you pay.

The insurance doesn't START paying, until AFTER you've paid bills equal to the deductible. Then, you KEEP paying copays and coinsurance, until you reach the total out of pocket maximum.


What would be an example of a group health plan?
Q. Are Aflac and Blue Cross Blue Shields Group Health Plans?

I'm asking for an assignment in my medical office class. I'm trying to figure out what to put in Block 1 of the CMS 1500 claim form.

A. Group health plan? Hmm well I know the difference between an insurance and a medical group not sure if that's the same. For example if a patient has Blue Cross and it is an HMO policy the medical group would be Arta Monarch or Family Choice << those are medical groups that fall under HMO's.


How can a person switch health plans?
Q. I want to switch health plans, but from reading the online applications, I haven't had this health plan that long. Most of the applications said that I have to have coverage of at least 18 months before switching. Is that true? Do I have to wait 18 months of having Kaiser permanente insurance before switching?

A. In addition to what mbrcatz said, I'd also like to point out that it doesn't have to be 18 months of coverage with one insurance company.

So, if you had coverage with XYZ insurance for 1 year and then started this Kaiser policy without a break in coverage, you'd want to add the time you've been with Kaiser + the time you were with XYZ.


What is a good affordable health plan to get?
Q. I am a single 25 year old healthy male. Are there any truly affordable health plans out there for me? And don't say that $300 a month is affordable, because its not. I don't need any major medical coverage. I haven't had insurance for 6 years and haven't been to the doctor in those six years. However, my eyesight isn't great, so vision coverage would be good. I also want dental coverage as well. Any suggestions?
I forgot to mention that I live in Oregon.

A. I think it's cheaper to pay cash, insurance is merely a coupon.





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