Another medical insurance question

[photomile 101]

Alright, I'm admitting defeat. Yup, I'm British, I've been spoiled with the NHS, but for the life of me, I cannot get my head around the American Health insurance system. The terminology seems confusing as hell as well.

Is there an idiots guide to it somewhere? On one hand, There seems to be health plans that, almost say, here's $5000 for your eligible medical expenses, once you've been to the doctor enough times to use that up, then you need to pay for some of it, and we will pay the rest (this is co-pay, right? wrong? you pay 30% they pay 70% of the remaining costs?)

Or is it the other way around, you have to pay the first $5000 of ANY medical expense, Then they start to pay for it, OR is it, 'We will ALWAYS pay 70% of the cost, but your 30% will never exceed the $5000 dollar mark'

Then there's HSA, then there's.... every.....

I'm stumped. I really am. It's obviously not clicking, and I'm being incredibly stupid. Would someone, kindly, be able to link me to a site to explain this, or baby it a little?, I can upload the PDF summary for the health plan on offer for my fiancee in her workplace if that's of any help, because, they offer a HSA plan, which is cheaper, but I can't work out if it includes the savings account... or if it includes the high deductible plan... or...

[Penguin_ie 5,993]

Yeah I have been here almost 4 years now and still not sure I understand all of it...

- Deductible is basiclally like an excess it car insurance in the UK: you pay the first $1000 (or whatever), and the insurance pays after that.

- Co=pay is something you pay at every visit. For example, my insurance has a $30 GP co-pay and $60 specialist. That means if I visit my normal doctor, I have to pay $30 at the office; if I visit a OB/GYN or similar (which I can do without referal), I pay $60 at the office, and they bill my insurance the rest.

- Co insurance is the % thing; ie if your co-insurance is 25%, and your hospital bill is $4000, you;d pay $1000.

A good, basic overview here: http://www.healthinsuranceindepth.com/basics-how-it-works.html

[photomile 101]

Thanks. I found a good few videos as well last night. It seems deliberately designed to be as confusing as possilbe!

[Flames9_RN 358]

Make sure you know the difference between a HMO, PPO, etc. Just because a place accepts your insurance--that means very little,lol

[LeftCoastLady 441]

Make sure you know the difference between a HMO, PPO, etc. Just because a place accepts your insurance--that means very little,lol

Ditto on knowing in-network and out of network. Unless your'e in an HMO, you can see any doctor, but your insurance may not cover any/all of it.

I wish I could say Americans know the ins and outs of medical insurance, but the vast majority do not.

[Penguin_ie 5,993]

The other thing to consider is there may be yearly and lifetime limits... for example, the insurance may state they cover cancer care 100%, but there is a limit of 1 million dollars in a lifetime, which could be eaten up with a surgery and a lengthy hospital stay. Or in my own case, my son needs speech therapy- the insurance covers it 100% (no co-pay, we have a small deductible), but a maximum of 50 sessions a year, and he gets two sessions a week, so about 100 sessions a year; this means half way through the year, we will run out of insurance cover.

[M&Pooh 12]

General annual/lifetime caps are made illegal under Obamacare but DHHS gave out A LOT of waivers to the hundreds of insurers... they are supposed to be temporary ( 1 year ), though.

I am not sure whether this applies to the specific treatments ( i.e. number of physical/occupational therapy sessions ) as well or just to the aggregate annual/lifetime limits.

[photomile 101]

Thanks all for the help.. It is indeed a huge minefield out there!