When it comes to Health Insurance, some families are confused about their deductibles. Without the right guidance this could cost you a fortune at claim time. If your family doesn’t have anything going on outside of doctor visits you could be over spending on your insurance policy. At that point, the insurance company gets to keep the over spent premiums.

The deductible is the amount you pay in a single year before the insurance company kicks in. Be careful of plans out there that claim they are based on a 365 day period. If you read the next line it says for EACH Injury or Sickness period of treatment. This means if you have 2 completely different ‘periods of treatment’ in one year you will be exposed to two separate deductibles!! If you have what they call ‘Calendar Year Deductible’ once your deductible is satisfied for the year there are no more deductibles. This is outside of ‘out-of-network deductibles’ or ’service deductibles’.

The out-of-network deductible is the insurance company’s way of penalizing you for going out side of a preferred provider network. Usually this deductible can be anywhere from $2,000, or more commonly, twice your original deductible. Of course, this is in addition to your in-network deductible. The problem is that even if you’re admitted into an in-network facility for a scheduled surgery… the surgeon, pathologist, radiologist or anesthesiologist may not be a participating provider in your network… and you could easily be stuck with an additional $5000 or more out-of-pocket. There are only a few insurance carriers out there that do not have out-of-network deductibles. Once it is satisfied for the year, in-network or not, it’s satisfied, period. Check with your Health Insurance Specialist on these carriers.

Unfortunately, too many insurance agents like to steer their clients toward low deductibles like $500 or $1000. These are the absolute worst values! The lower the deductible, more the premium you have to pay each month.

Since agents get paid a percentage of your premium, in turn, the lower your deductible, the bigger their commission! Obviously, the agent has a financial disincentive to save you money. Be suspicious of insurance agents that recommend health insurance deductibles under $1500!
Affordable plans have deductibles of $2500 and up. The higher your deductible, the lower your cost. In fact the money you save will almost always far exceed any potential additional out-of-pocket expenses!

Conclusion: Work with a Health Insurance Expert. They will walk you through affordable options to lower your premiums to keep them affordable. Usually, your premiums savings will offset any potential out of pocket expenses. There is no point of over paying your policy ‘just in case’ something does occur. When that ‘just in case’ occurs you would have saved enough hard earned premium dollars to offset the out of pocket expenses.

By: Butch Zemar, President