Archive for May, 2011

Picking a private Health Insurance

May 20, 2011

Recently we needed to go for private insurance.  We found out that the HMO and POS were in general less costly, followed by PPO and finally came the Indemnity.

Below it is a simplified example to illustrate the differences and relationship between deductible and out of pocket max.

A couple of important pointers:

1. There are several web pages that point out to the importance of looking into the Lifetime Maximum per insured.  The one we selected shows $4,000,000+

2. Annual Deductible.  “The amount a member must pay for medical services before their health plan begins to pay for covered services. Some services are exempt from the annual deductible” http://www.fuzeqna.com/pebb/consumer/kbdetail.asp?kbid=533.  For example, say the plan charges 35% for Hospital Admission after deductible.  and the deductible is $6000 / family.  If the Hospital cost is $12,000 then the cost on the member is 12000 – 6000 = 6000 (to meet the deductible) + 2100  (2100 = 35%*6000).  Total cost to the member $8,100.

3. Annual Out of Pocket: “The max total you pay out of pocket for most covered services in a calendar year.  After you reach that maximum, the plan will pay for most covered services at 100%”.  For example.  Say the insurance out of pocket max is $11,000.  In the above example the member paid already $8,100.  If another charge comes along the member will need to pay $2,900 (11000-8100) and since the member hit the max out of pocket the insurance will pay after-wards.