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Originally Posted by DPancoast
I am pretty dumb on this subject as well. The plan she posted seems pretty legit, but can someone run how a deductible works again in lay-mans terms. I always get psyched out when I see "$250 deductible" or some high dollar thing like that because I feel like I have to pay that up front? I take generic drugs 9 times out or 10.
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Deductable is the same as on your auto insurance--you pay the first xxx amount, with the x being your deductable, they cover after that, but usually at a percentage these days. If you hate doctors and are healthy, high deductable is good. If you have diabetes or asthma or any other condition where you see the doc more than once a year on a regular basis, low deductable is good. Kind of like if you're living in Princeton, or Camden. If you live in camden you don't want a 2,000 deductable on your auto theft policy
But the parts by SiR about caps are not quite right...caps are usually referred to as the most the INSURANCE will pay.
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Some insurance plans cap the amount per individual and family, once you have met this limit, the plan covers 100% of the eligible expenses. It also doesn't cover anything out of network, so any cost incurred from visiting a non-participating provider will be 100% your responsibility.
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caps are a BAD thing because if you are in a wreck, then rehab, when you reach your 1 million or whatever cap, they STOP paying altogether. So if you get cancer or some other life altering condition you want NO caps. (which usually makes an expensive plan). As for HMO vs PPO this is made into a bigger issue than needs be, most PCPs will hand out referalls to specialists like its nothing, and on top of that most lay people don't know when they should see a specialist vs PCP. I am a big proponent of PCPs because they tend to see the big picture and not just the 'parts' they are looking at.
In vs out of network, this depends on the carrier. Keystone is a big plan and they have a big network from what I hear. The important thing is that the ER and emergencies are 100% covered out of network. So if you are traveling to california and get hit by a truck or come down with the swine flu you are not getting 20% of the $150,000 bill.
If you go the HMO route don't worry about getting a PCP that does OB as well, you should only need one referral to an OB and from then on you can just see them as you like.
I'm interested to hear what its going to end up costing you though, it was 400 to
COBRA mine almost 10 years ago now, and that's at like half of what it actually cost...