What’s The Best Copay Or Deductible For Your Insurance?

The copay and deductible on your health insurance policy has a tremendous impact on the rate that you pay. A higher deductible will reduce your premium, and the savings could be substantial. And of course, lowering the copay or  deductible will raise your premium, and perhaps cause you to pay for coverage that you rarely or never use. So when you purchase medical insurance in Indiana, what do you do? We help you decide the best choices.

Your  Options

Most healthcare providers in Indiana offer a wide range of  options. Deductibles as low as $500 (sometimes $250 or $0) can be found along with options as high as $6,850! And yes, with a combination of high deductibles and no copays, you will be paying for everything out of your own pocket. But your premium will be extremely cheap! HSAs often have similar options. (Additional HSA information can be found here.)

Typically, a deductible between $2,500 and $5,000 will make the most economical sense. However, if you qualify for financial aid, a “Silver” or “Gold” tier plan will allow you to obtain high-quality benefits at a very low premium. Also, Silver-tier contracts are eligible for “cost-sharing” reductions, which can reduce the deductible by thousands of dollars. Your household income determines your eligibility and reduction mount.

NOTE: The $25,000 deductible mentioned above can be found on some “off-Exchange” short-term plans. Although the rates are very inexpensive, they do not include many mandated and required benefits required by the Affordable Care Act legislation (ie maternity, mental-illness, pediatric preventive etc…). Also, a mandatory 2.5% household income surcharge (tax) will apply on these types of policies. The issuing companies are also not likely to be “name” carriers such as Aetna, Blue Cross, UnitedHealthcare and Humana.

When determining which option is right for you, it’s important to consider your health and how many claims, and what types of claims you typically have in a year. While you don’t want to pay for benefits you will never use, you certainly don’t want to leave yourself in a position where a large claim will cause a financial dilemma. However, if you were to choose the “high deductible” path and subsequently incur a major claim and thus, face a large out of pocket bill, there may be help.

Lower Deductible But High Out-Of-Pocket Expense

Many Indiana Exchange plans feature a low (or fairly low) deductible. However, the maximum out-of-pocket cost is significantly higher because of coinsurance, copays and other items the applicant is responsible for. Although these policies are offered by reputable carriers, it’s important to note that your financial obligations don’t end after the deductible.

Plans shown below include the name of company, plan identification, deductible, and maximum out-of-pocket expenses. We have selected several policy options that offer deductibles less than $5,000.

IU Health Plans Bronze HSA – $4,500 and $6,200.

MDWise Marketplace Bronze Plus – $4,800 and $6,850.

MDWise Marketplace Silver Coinsurance – $3,500 and $6,000.

Anthem Bronze Pathway X  4950 50 – $4,950 and $6,850.

CareSource Just4Me Silver – $3,500 and $6,500.

IU Health Plans Silver HSA – $3,000 and $4,500.

Ambetter Balanced Care 10 – $4,500 and $6,500.

Anthem Bronze Pathway X 4850 20 – $4,850 and $6,850.

 

NOTE: If you enroll in a Silver-tier plan, and your family  income is between 100% and 250% of the Federal Poverty level,  your deductible may significantly reduce. Also, although not listed PHP individual plans are very competitive in the Northern counties.

Indiana Medical Plans At Cheap Rates

Large Healthcare Bills Can Be Paid

What About The Large Bill?

Usually, it’s a large hospital bill that is the biggest challenge. It may just be a few thousand dollars or perhaps as much as $10,000 depending on your policy limits. But many hospitals and similar medical facilities will negotiate your obligation and perhaps offer attractive and flexible terms regarding payment of the bill. Although it’s not their financial obligation to negotiate with consumers, they often will since it is often the only way to collect a debt.

For example, assuming that after all of the claim forms had been processed and the treatment had been completed, let’s suppose your outstanding bill was $6,000. And of course, this was owed to the hospital that treated you. Although it’s not guaranteed, you may be able to negotiate a budget-friendly payment plan. Perhaps $150 per month for four years or even $125 per month for four years. Each hospital will have its own guidelines. You may also be offered a lump-sum payment option of about 60% of the outstanding balance.

Financial Assistance

Any obligation or balance not covered by your private or employer-sponsored coverage is your responsibility and will be billed directly to you. Contractually, you have the fiscal responsibility to pay the bill, or negotiate an agreed settlement (approved by both parties), if you don’t have available assets to pay the balance. It is likely that you will receive  bills from multiple sources, including a hospital, specialists, doctors, and other facilities that treated you.

Typically, if you can not pay your major hospital bill, you may be asked to complete a short application for financial assistance. Some of the information required includes your sources of income for the last three months, most recent state and federal tax returns, healthcare ID cards, and most recent 90 days of pay stubs from your employer. Also, any child support, alimony, credit card, or retirement/pension statements may also have to be furnished.

Important: We do not encourage any patient to ignore or simply not pay a bill. We are simply pointing out that in some instances, you may be able to alter the terms. Each hospital will have different billing procedures. Some of the larger hospitals in the state are Indiana University Health Methodist, St. Vincent, Franciscan St. Francis and Ball Memorial. Bigger and profitable hospitals are more likely to agree on an attractive settlement-option.

UPDATES:

December 2014 – For 2015 plans, the maximum deductible per person (and out-of-pocket maximum) is $6,600. For family coverage, the amount increases to $13,200. If there are no existing medical concerns and household income excludes you from receiving a subsidy, a “Bronze” option may be one of your best choices.

April 2016 – For 2017, it was announced that maximum deductibles will rise to $7,150. Typically, many Bronze-tier plans will feature the highest allowable deductible options.

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