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The Deductible

For the remainder of the summer, we will be reposting educational material on Health Insurance Basics which were originally aired in 2021, with updated 2022 figures where appropriate. If you didn’t watch these videos, please do, and tune back in after Labor Day for new material. Thanks, and have a wonderful summer.

The deductible is the annual amount you owe before your insurer pays although there are some services like well-care or other visits often covered before meeting the deductible. The tricky issue with deductibles in healthcare is that there can be so many of them and they can range from zero to thousands of dollars.

The deductible and other health insurance basics videos are available for viewing now at healthcarenavigation.com.

Some people have separate pharmacy, in-network medical and out-of-network medical deductibles. Others have plans where all claims expense accumulates against an aggregate deductible. Some have plans that allow all in-network claims to be applied to the out-of-network deductible. Still others have an embedded deductible where one individual in a family can meet an individual deductible and all other family members’ claims aggregate against the family deductible.

And then there’s Medicare. In 2022 the Part A Medicare deductible is $1,556 for each benefit period (not an annual deductible) and the annual Part B deductible is $233. Advantage Plans (Medicare Part C) have varying deductibles. Many are zero deductible plans but with copayments for most services. Medicare Part D plans are limited to an annual deductible of no greater than $480 in 2022 but many Part D companies offer various plans with different deductible levels.

Because this is so vexingly complex, mistakes are made. If you have no idea how your deductibles are structured or the amount, then you are in no position to know when you get a bill that might overcharge you. Always maintain an on-line account on your insurance company’s web site portal so that you can review how your plan is structured and how claims are applied against the deductible over the course of the year.

Trust is an admirable trait. In our opinion, however, to trust that all your claims are processed flawlessly against various deductibles is deeply unwise. If you care about your money, take the time to understand how your deductibles work.