Pulaski

So why do they set an individual deductible if, as you suggest, it is overridden by the family deductible?

Phyzz

I have opted for the High Deductible plan that my company offers. Along with the benefits of lower premiums, HSA, company contribution etc. that others have outlined; it also gives us the lowest Max OOP when factoring in all of the costs including the premiums paid.

We are generally a healthy family so have not been meeting the deductible. This year my son was injured playing soccer. With ambulance fees, surgery costs etc. I have hit the max OOP so the remainder of the year is now essentially 'free' (excluding premiums and HSA contributions).

It is worth digging into the details, although it is a little daunting. What on the face of it offers the best coverage could be the least efficient use of your money. I was lucky the company provided a nice tool for comparing all of the policies that they offer.

chawkins99

Not in our case. My wife has already satisfied her individual deductible. Anything else is covered at 80%.

I haven't used any of my deductible but that doesn't affect her.

As there are just the two of us, we both have to meet the individual deductible to satisfy the family deductible. In a larger family, once the family deductible is reached, the individual deductibles are irrelevant.

All dependent on the policy. YMMV.

mrken30

Because some people take individual cover. They may be single or their spouse may use their own insurance. This is where the individual deductible amount is used. I have my family on the plan, hence the family deductible kicks in. My premiums may be very low because of this, $30 per pay period for family cover.

Steve_

There isn't one, US healthcare coverage is extremely complex.

For most people, they have coverage provided by their employer and then when they get to 65 they sign on for Medicare. That is as dumbed down as it gets because each employer has a different plan and it varies from State to State as to which plans there are. If your employer is a smaller employer (less than 50) you might be on an ACA plan (see healthcare.gov)

If you don't earn enough you might be on Medicaid (and at what level depends on which State you live in because they may not have signed up for the expansion) and your child might qualify for Medicaid CHIP even if you don't.

Medicare is also complex, even if you qualify for Part A you will want Part B and D usually at least as well.

And even if you have insurance, there are co-pays and deductibles and if you end up in hospital, you might think you're insured but then your insurance plan might cover the hospital but it might not cover the specific physician you're seeing at said hospital, some States (Florida and NY) require them all to be covered by the same insurance but in most States they don't.

There is no simple way of describing it, it's really really complex and I didn't even get into prescription drugs.

The insurance companies have leaflets trying to explain it and so does Medicare.

Just bear in mind that at all times and in all cases they are trying to rip you off. Have a look at the Medicaid National Average Daily Cost for prescription drugs for example (NADAC). Everything on there is fantastically more expensive than in Canada. A 10ml vial of Novolog insulin for example is listed at $264. In Canada it goes for CAD $35.

Once when I got treated in Florida they tried to rip me off by dumping the whole ER bill for the day onto my insurance - I didn't have insurance, so I got the bill directly. I did note however that I was the only white person on the ward that day.