S/O Heath Ins. Deductible

[ha98ed14]

What's your premium per month?

What's your deductible?*

What's your co pay for a regular sick kid ped visit?

*If you have a deductible, does that mean you pay 100% of the cost of the visits until your max out your deductible? If so, then there are no co-pays? Or if there are co pays, do they count toward the maxing of your deductible?

[Elilly]

We have an HSA. No monthly premium except what DH's employer pays. Our family deductible is 6k. A bargain for us considering DS's immune deficiency. Everything is covered 100% after that. Thank goodness. We switched to this because we were getting eaten alive by paying the copays for every Dr visit and for the 15% coinsurance on top of our premiums.

[KrisM]

We don't have a monthly contribution. We have a $3k deductible and we get $1k each year in a HRA from DH's employer that can roll. Things like child well-visits, vaccines, and 1 physical per adult per year do not apply to the deductible are are 100% covered. After our deductible, we pay 20%.

[justlearning]

I don't know our monthly premium.

Our deductible per person is $4000 and $8000 for the family. Until the deductible is met, we pay 100% of everything. After the deductible is met, we pay 10% of everything. Prescriptions aren't covered at all so we always have to pay 100% of that.

[o_mom]

We have an HSA. Premiums are $90/mo. $3k deductible which has to be met first, then 80% coverage to a max coinsurance of $5k (so $8k total out of pocket max). Some routine stuff is covered 100% before the decductible like well-visits, mammogram, etc. Company contributes $1k/yr to the HSA and we pay another $430/mo into it.

[Tondi G]

we pay approx $1300 a month. we have have a $45 co-pay for office visits. our deductible is $2500 and we pay 30% of everything once the deductible is met. we do have prescription coverage ... most meds are inexpensive $10 or $20 .... but if we need a name brand we have to pay for it!

there is an ER fee or deductible and there is a Maternity fee or deductible that are not a part of the regular deductible.

still dreaming about the days when we had a no deductible $20 co-pay plan pre kids! It's no wonder my husband is so hung up on not being able to afford another child.... our health coverage just keeps getting more and more expensive and they keep covering less and less.

[baileygirl]

We pay $25 a month and have a $8k deductible (no copays, covered at 100% after 8k). Things like well visits/vaccines, etc are covered at 100%. DH's company puts in $2k+ (think this year it was 2600) towards the HSA (believe that is the correct term). For something like a sick visit, we usually pay a cheaper rate then what someone paying cash would pay (i.e. $80 vs 120).

[lilycat88]

We pay$264 a year.
$3000 deductible - we pay 100% of contracted rate.
$8000 out of pocket - we pay 20% of contracted rate until we meet $8000 OOP.
Prescriptions are covered just as everything else is and count toward deductible and OOP.
Wellness visits, well child visits, immunizations, mammograms, paps, etc. are covered at 100% and do not count toward deductible or OOP.
DHs employer contributes about $2500 a year to a HSA and they frontload 50% of that so we have it available on January 1. The remaining is deposited monthly.
We cover the rest by taking out about $5200ish from my paycheck and putting it into a flex plan. Without the recent craptastic health stretch, we pretty much knew we would meet the OOP because DS is going to have surgery at some point this summer and our other "standard" expenses are pretty hefty.

[BayGirl2]

We have Kaiser Permanente HMO and great coverage. Maybe ~$150/month for family coverage, DH's company pays the rest. $25 sick visits, $5 well child and OB visits, $100 for birth/hospital stay. No deductible and excellent preventative care.

I love the care I get at Kaiser and their use of technology. HMO's got a bad rep back in the '80s, but not the case anymore. IME Kaiser does a good job of balancing good medical care with cost consciousness.

[egoldber]

We have a PPO.

I pay $600 monthly for family coverage.

We have a $300 family deductible that does not include co-pays. We pay $15 for a doctor visit. Kid well visits for kids under 3 are free, but that doesn't help me a whole lot.

We have a separate mental health deductible ($300) and the co-pay structure is different. But no one we see is in network, so we do everything OON and get paid back at 60%.

[Penny's Pappa]

What's your premium per month? Our plan is subsidized by one of our employers. Our monthly contribution is $78.

What's your deductible?* $500/$1000 (Individual/Family)

What's your co pay for a regular sick kid ped visit? $25

*If you have a deductible, does that mean you pay 100% of the cost of the visits until your max out your deductible? If so, then there are no co-pays? Or if there are co pays, do they count toward the maxing of your deductible?

Our office visits are co-pay only. They don't get applied to our deductible. For charges that are applied to the deductible (say, hospital stays), we pay 100% up to the deductible then 80% after that until we hit our out-of-pocket max.

[hillview]

We pay $356 a month for a PPO. We have a co pay that ranges between 10 and 20 dollars a visit. $100 payment for ER visits.

ETA
This is my employer's package -- this is our contribution. This covers the 4 of us including dental (not totally sure other than regular xrays and cleanings are covered 100%) and vision (annual eye exams and $250 every other year for glasses).
/hillary

[g-mama]

What's your premium per month? $800

What's your deductible?* $3000 (family); meaning we have to pay $3000 out of pocket for all bills before insurance starts paying anything. Our prescription plan has a $1000 deductible before it begins paying anything.

What's your co pay for a regular sick kid ped visit? $40

[kijip]

The premiums are 100% employer paid for my husband and the kids and his employer pays half of the premium for me. We thus pay about $240 in payroll deductions for me plus dental. It is a huge group plan so I am sure they pay less than many groups. We pay $15 copays, $50 er, waived if you are admitted to the hospital and the hospital stay copay is either $75 or $100. We have 100% coverage after a very low deductible (like $400 pp, seriously) and most prescriptions are $5, some are $20. Co-pays do not count towards the deductible. We are very fortunate to have such good coverage, moreso because my husband actually only works a .6fte That is how good the health benefits are. Ftr, no my husband does not work for the government. He works for a large non-profit hospital.

Just a note, if it is employer paid it is not free ... Not only is your employer paying for it, it is coming-out of resources available for your compensation. With healthcare there really is no such thing as free. Someone is paying.

[Pyrodjm]

Our insurance is through DH's employer. He contributes about $70 a month. We have no deductible as long as the providers we choose are in-network. We have a $15 copay for all doctors visits.

[AnnieW625]

Another Kaiser HMO family here. We do not have to meet a deductable.

We pay $202.71 per month for our family coverage. DH's employer covers the rest of the $1200 monthly premium.

We pay $15 for sick child visits (including urgent care); well child visits and yearly physicals until the age of 4 or 5 are free.

Immunizations, and flu shots are free.

Maternity care including u/s, all lab work, and l/d+hospital stay were free.

Most generic RX are $5 per month, and or $15 for three months

Name brand drugs have a cap at somewhere between $45 and $100 IIRC (we are okay with generics so that's what we usually get).

I think that the ER visits are somewhere between $35 and $50 (waived if admitted to the hospital, I believe). Surgery co pay at a Kaiser Surgery Center is $15. My D&E surgery at a non Kaiser surgery center was $75.

Overall we are very happy with our plan, and there has only been one dr. that I refuse to see (an opthamologist) again because of how he treated DD1 and myself, but overall I have been very happy.

For dental we pay $30 a month. We had to pay $140 for DH to have some teeth filled, but otherwise they have covered everything. I think we have $1100 in braces care per child so we'll most likely switch to a different PPO plan that is offered to get $1900 of braces per child when the time comes.

[ett]

Our premium is $122/biweekly and the deductible is $2500. When we hit that, 80% is covered. It's 100% coverage when we hit another higher deductible. (DH can't remember what this deductible is). Prescription costs count toward the deductible. Employer contributes 1K to our HSA.

[mezzona]

last year dh was freelancing. monthly premium for 3 was $700. deductible was $3000 for family. co-pay was $0. cost of office visits and prescriptions was out of pocket, 100% until deductible was met.

now coverage is thru employer. premium for 4 = $0. deductible is $2400 for family. after deductible met, coverage at 90%. co-pay = $0. sick visits = $0. employer also contributed $300/month into HSA.

[justlearning]

Is there a prize for the person with the worst insurance? :) It looks like I would be in the running for that.

Reading this thread has led me to have insurance envy! It would be so nice if we got some type of break until meeting the $8000 family deductible--it's hard paying 100% of everything with no discounts or co-pays for any type of visits (including well child, sick, hospital, physical therapy, whatever) and with our meds not counting at all. And it also stinks to have to keep paying 10% after paying the $8000. But considering that our insurance has had to pay out quite a lot for DS' cancer treatments, I'm still thankful that we at least have insurance.

[kijip]

Is there a prize for the person with the worst insurance? :) It looks like I would be in the running for that.

Reading this thread has led me to have insurance envy! It would be so nice if we got some type of break until meeting the $8000 family deductible--it's hard paying 100% of everything with no discounts or co-pays for any type of visits (including well child, sick, hospital, physical therapy, whatever) and with our meds not counting at all. And it also stinks to have to keep paying 10% after paying the $8000. But considering that our insurance has had to pay out quite a lot for DS' cancer treatments, I'm still thankful that we at least have insurance.


Do you have any out of pocket max? Not knowing the max oop would be really a source of worry for me.

Also, it you don't have prescription coverage at all and ever have a very pricey medication to take, see if you can get some directly from the drug company. My mother needed some uncovered, pricey medications from time to time but we could usually get all or part of it donated to her through the drug companies.

[LMPC]

We pay about $80 a month in premiums and contribute $250 a month to an HSA. We have a high deductible...I want to say $2500 for a person. Well visits/ annual exams are covered $100. No copays for visits. When I have taken DD for EI, etc. the dr typically charges $160, of which insurance adjusts/allows about $60 less. We end up paying about $100 that goes towards our deductible. If we were ever to meet the deductible (actually, I did the year DD was born) then we are covered 80% after that.

[vludmilla]

Employer provided plan:
No deductible. PPO. Free well child visits and annual adult exam. ER visit is free if it is an emergency and not misuse. $10 sick child or adult visit. $25 specialist visit. $5-25 for prescriptions. $3 million dollar lifetime max. I'm not sure what my contribution is for this but I think I pay 10-%15 of the cost deducted from my income pre-tax.

[niccig]

$270 a month - includes dental, vision, DH's disability, so everything.
$500/$1000 individual/family deductible
Annual check up is free, we pay 100% until reach deductible, then it is 80-20 I believe. We did not hit deductible last year, so I do not know what cost would have been.

[oneontheway]

Wow, I didn't realize how lucky we are. We don't pay anything monthly for a family of 5. $15 for pcp, $25 specialist. $35 for the ER. 0 for hospital stays including births. My son just had surgery at CHOP and we paid nothing. Prescriptions are either $6 generic or $9 for brand names.

[justlearning]

Do you have any out of pocket max? Not knowing the max oop would be really a source of worry for me.

Also, it you don't have prescription coverage at all and ever have a very pricey medication to take, see if you can get some directly from the drug company. My mother needed some uncovered, pricey medications from time to time but we could usually get all or part of it donated to her through the drug companies.

We do have an out of pocket max but it's very high (either $12K or $15K, can't recall now). We haven't hit that because during the first year of DS's treatment (and the most expensive), we were with another insurance provider that didn't make us pay anything once the deductible was met.

And yes, we have been fortunate enough to get some samples of meds but not for everything. But again, our insurance was better that first year so his meds then were covered under the plan.

[g-mama]

Wow, I didn't realize how lucky we are. We don't pay anything monthly for a family of 5. $15 for pcp, $25 specialist. $35 for the ER. 0 for hospital stays including births. My son just had surgery at CHOP and we paid nothing. Prescriptions are either $6 generic or $9 for brand names.

Incredibly lucky! I forgot to mention that we pay almost $200/month for our youngest ds' asthma medication, as well. And we've never had dental insurance b/c it doesn't make financial sense to. So we pay all of our dental bills, as well. Dh works for a huge law firm and I wonder sometimes if we'd be better off buying private insurance. The support staff (secretaries, paralegals) pay almost nothing for their premiums in comparison to the attorneys and partners.

[niccig]

Wow, I didn't realize how lucky we are. We don't pay anything monthly for a family of 5. $15 for pcp, $25 specialist. $35 for the ER. 0 for hospital stays including births. My son just had surgery at CHOP and we paid nothing. Prescriptions are either $6 generic or $9 for brand names.

Do not change jobs!
DH is looking to change employees and we know our insurance will get more expensive.

[Puddy73]

Monthly premium is $850. Deductible is $2k per person, $4k for family. We pay 20% after deductible is met. Does not include maternity, therapy or prescriptions. Co-pay for Dr. visits is $40 regular, $50 specialist. We are self-employed so this is all out of pocket.

[cckwmh]

We are very lucky, too!!! Dh's employer pays 100% for the entire family, we have a PPO. We pay $10 co-pay for pcp and specialist visits. No hospital copays, no deductibles, and speech therapy is covered. prescriptions are $5-15.

ETA: fix typos

[cindys]

Up until a year ago we paid no monthly premium....But we now pay..

$75/month premium for our family of 5...No deductibles..$20 co-pay(including specialists) ...physicals, mammos, and baby visits are no charge...prescriptions $10..

We also have dental and eye vision which we have no charge for.

Cindy
Mama to 3 boys...19, 4 & 2 :heartbeat::heartbeat::heartbeat:

[AshleyAnn]

Depends on DH's Army situation. When he's home or on short term orders (under 30 days) we have no issurance. So its all OOP for us. We had state medicaid for DD but we no longer qualify.

If he's gone on orders over 30 days then we have TRICARE. At his current rank thats a $100 deductible and copay of 20% allowable charges.

When my job situation gets settled we'll enroll in Tricare reserve select and then it will be $197.76 per month for Tricare 100% of the time.

[vonfirmath]

What's your premium per month?

What's your deductible?*

What's your co pay for a regular sick kid ped visit?

*If you have a deductible, does that mean you pay 100% of the cost of the visits until your max out your deductible? If so, then there are no co-pays? Or if there are co pays, do they count toward the maxing of your deductible?

No premium
$1000 per person deductible
$40 co-pay

No. There are co-pays regardless. Co-pays do not go toward deductible. Office visits do not count toward deductible. Deductible is for procedures, surgeries, etc.

After deductible, we pay 20% of all expenses.

For maternity, we pay deductible for new kid from day 1 of kid's life and 20% thereafter, again.

[jess_g]

We have 2 policies. One is an HMO through my dhs work. We pay about $300 per month for family coverage. Copays are $20 and there is no detuctable. They have always paid for hospital stays, day surgeries, etc. We have no coplaints with our HMO. There are a few drs. we can't see because they are not participants with our plan but we can live with that.

We also have 2 kids covered under the state plan. We pay $160 per month and they pay anything the HMO does not pay. I don't know if we need this plan but since we are in it, we figured we might as well stay in it. I think it pretty much pays for itself with the copays and extras that it pays out for us.

I loved reading about Kiaser. My mother has been telling me how great they are for years.

Jessica.

[secchick]

$25/month for me and children PPO (DH is on his own). There would be no premiums for employee only.

$2500/yr, $5K OOP max. My employer puts $1K into the HSA every year and, as required, well visits do not require additional payment. Prescriptions, office visit fees, lab work etc. all count towards the deductible and after that, we pay a 20% copay until we hit the OOP limit. Fortunately, with the employer HSA contribution, if we hit the $2500 deductible, we are still even as to what we would be out of pocket with the difference in premiums for the traditional plan. Add in additional wellness incentive dollars and the benefit of our additional HSA contributions and we come out ahead.

[Binkandabee]

My employer covers 100% of our premium, but the premium is $1,044.00 per month. That is for a $500.00 deductible ($1,500.00 max per family), $15.00 co-pays for any in-network Dr., $100.00 ER co-pays. For prescriptions we pay 100% until we reach our deductible, then they reimburse me at 80%, but the prescriptions are as a reduced rate. We are very, very lucky.

[bisous]

We're another super happy Kaiser Permanente health plan member. We pay slightly more than the others--closer to $300 per month for our monthly premiums those are still largely subsidized by DH's work.

We have no deductible. Copay per office visit is $20 to see anyone from Family Care to a speciality. Lab work, x-rays, etc are all free. DH had an inpatient surgical procedure that cost $20. Prenatal checkups are free. Well baby visits are free.

Prescriptions cost $10 per month for generic $25 for name brand. The best part in the whole plan for us is that DME cost is $0. DS1 has Type 1 Diabetes so test strips and insulin pump supplies are FREE. This saves us hundreds of dollars a month. We are thrilled with our health insurance. :)

[blue]

What's your premium per month?
What's your deductible?*
What's your co pay for a regular sick kid ped visit?
*
Edited: incorrect info, will fix later (oops)