Out of Pocket vs. Deductible

[padthaiforlunch]

Ok, maybe I'm missing something simple here but I'm having a hard time with OOP and the deductible.

Specifically, I'm looking at a Kaiser plan with $5k/yr OOP that excludes copays and the deductible of $2k/yr.

So, client goes to hospital and....?

coinsurance kicks in up to the deductible, right?

So wtf, how do I explain OOP?

 

[insuremojo]

Total OOP for the client could be $7000 or more with copays.

$5000 OOP exluding the deductible just means that the deductible is separate from the $5000. Factor in copays and the cost could go up even more.

Basically client is responsible for the 1st $2000 (deductible) then the coinsurance kicks in at whatever rate (20%, 30%, 40%...) until the
$5000 is met. Copays are excluded which means they never go away.

Hope that helps.

 

[padthaiforlunch]

Total OOP for the client could be $7000 or more with copays.

$5000 OOP exluding the deductible just means that the deductible is separate from the $5000. Factor in copays and the cost could go up even more.

Basically client is responsible for the 1st $2000 (deductible) then the coinsurance kicks in at whatever rate (20%, 30%, 40%...) until the
$5000 is met. Copays are excluded which means they never go away.

Hope that helps.

Thank you so very much!

 

[STIBROKER]

DUDE....a deductible comes first......out of the clients pocket ....then coinsurance kicks in....80/20,75/25, to a stop loss amount for the client...could be $2,000,$3,000 depending on the contract....could be 100%....so read your specimen policy on what you are selling....and if your selling UA....never mind....

 

[fostever]

Ok, maybe I'm missing something simple here but I'm having a hard time with OOP and the deductible.

Specifically, I'm looking at a Kaiser plan with $5k/yr OOP that excludes copays and the deductible of $2k/yr.

So, client goes to hospital and....?

coinsurance kicks in up to the deductible, right?

So wtf, how do I explain OOP?

I don't mean to be mean but how long have you been selling major medical? You need to go back to bootcamp. Satisfy Deductible 1st then co-insurance. Some preventative stuff can be co-insurance only depending on the policy. I'm sorry but you're scaring me.

 

[somarco]

Some plans, Aetna comes to mind, include the deductible in their OOP wording. Most set the OOP limit in addition to the deductible.

Separate deductibles, such as for Rx, ER, etc are not included in the OOP limit, nor are copays.

So as pointed out above, your OOP is not finite. Throw in some non-par charges by hidden providers (such as anesthesia, lab, radiology, ambulance) and the OOP can really jump.

 

[insuremojo]

Geez guys, maybe I was too nice?

It is pretty scary agents are selling health and don't even know the basics....

 

[padthaiforlunch]

Geez guys, maybe I was too nice?

It is pretty scary agents are selling health and don't even know the basics....

Where's your team spirit man? Act like a douche bag and jump down my throat for having a lapse of memory after too much bookkeeping. Get with it!


Fostover: no, I haven't sold much major med. Kinda slept through that part of the training. I went into this with a focus on life and annuities. But a BIG SHOUT OUT to all the guys on this board who have inspired me to use health as an opener.


For all you kids out there thinking of jumping into this biz a an independent, you have the good fortune to observe the perils of bootstrapping -- public ridicule and SHAME for daring to ask such an elementary question!

Really guys, thanks for the ball tickler! (I kid.... it was a v-8 moment as soon as I read mojo's response.)

 

[GreenSky]

Fostover: no, I haven't sold much major med. Kinda slept through that part of the training. I went into this with a focus on life and annuities. But a BIG SHOUT OUT to all the guys on this board who have inspired me to use health as an opener.

It might be offensive when someone writes "It is pretty scary agents are selling health and don't even know the basics...." but it's the truth. You're potentially playing with someones financial security. It's unethical to be an amateur.

Questioning deductible vs OOP and still admitting that you have sold health insurance is scary. How can you advise your clients about an insurance plan when you don't know the basics?

You might want to start a post saying, "I don't currently sell health insurance so I need some elementary questions answered." No one will fault you for lack of knowledge. However, selling a product when you have no idea how they work is borderline criminal!

Maybe you could find a "friend" who does sell health in your area and buy that person lunch in exchange for some training. Additionally, every company your are contracted with has broker reps that are out in the field. I'm sure they will be happy to share their limited information with you.

Good luck and PLEASE, stop selling until you understand the product.

Rick

 

[007]

That is scary... glad I'm being trained RIGHT by one of the best health agents in the nation...