Health Insurance

[Kristinmcall]

First just let me say that I'm sorry to be asking such a completely silly question, but I'm too embarrassed to ask DH since he apparently thinks I understand.

We're close to meeting our health insurance deductible for the year and DH is urging me to get in for any health issues I want to clear up (I do have a couple) before the end of the year so we'll meet it. Why does he think it's so important to meet it for the year? Don't things just start over next year? Does meeting it this year affect next year in some way? I just don't understand. I've always let other people worry about things like this but I guess it's time to start making sure that I understand everything!

[MissLotus]

Do you know, I didn't know how it really worked either...but got divorced this year (now I have COBRA through ex's employer) and I recently had surgery, so I've had to figure it out pretty quick!

Once you've met your deductible, that's when the insurance company has to kick in their full share to pay your bill. And yes, the deductible starts over again at the new year, so that means it'll take a while till you're at the point where the insurance company will kick in their full share. So it's best to go NOW, while they're obligated to pay for it, rather than to go after the new year...and be responsible for the whole thing yourself!

In other words: I had my tonsils out in October. I simply thought insurance would cover it. But then the medical bills started rolling in....and the insurance company says they hardly have to pay ANY of it, because I "hadn't met my deductible" by the time I had the surgery! So you see, if I'd already met the deductible, I wouldn't be getting these bills.

But I should add...I think I HAD met the deductible by the time I had surgery....it's just the information hadn't been "rolled over" when I started getting COBRA. So now I'm waiting for them to re-process everything. I'm sure this is garbled...it's very late...but the point is, Yes, it makes a big difference in what you have to pay out of your own pocket!

[jeca]

Next year it will start over but any that you did not use will just be lose. He probably just wants to use the last of it this year so next year can be saved for something else if you need it. I think if you can get in this year you should. At least that's the way it works with our dental.

[mightymoo]

I think it isn't so much that he's itching to meet the deductible, rather that if you have a lot of heath care spending, better to meet the deductible and get the overage paid by the health insurance than to wait until next year and have to pay all of it.

Scenario: your deductible is $1000, you are at $950, but you have a constant backache which could cost $300 to fix. So, better to do it this year, spend $50 and get insurance to pay $250 (or a larger portion of that) than to wait, and pay all of the $300 yourself in January.

If you weren't close to the deductible for the year, it would be better to wait and contribute towards next years deductible. Either way, my experience is that getting in for tests takes so long you are probably too late. (I also had some issues I wanted to clear up before the end of the year, but apparently gastroenterologists book a month out and it took a month to get the referral point, so oh well)