What the Healthcare - Deductibles, Coinsurance, and Max out of Pocket

[@fantomlimb5008]

Holy Cow! This helped so much. Some people are just great teachers and you are one of them. Thank you.

[@Sp4wnK3lla]

One of the oldest videos on KZbin about Health Insurance but it makes the most sense! Thanks dude!

[@davidallyn1818]

Great breakdown Joe! More plans should be explaining it in these terms. Also, I think employers should explain their plan comparisons this way - BRAVO!

[@healthcaremadesimple5367]

I agree David. Most people have no idea what they are getting themselves into. Appreciate it man!

[@davidallyn1818]

@@healthcaremadesimple5367 I was an analyst for a student health insurance broker back in '13 for about 7 years, and we were highly successful mostly for how we could explain our plans to our in terms of actual impact to the pocket. "If you have a broken arm..." is a really great place to begin (people are stunned that it costs >$$10K); we'd used Diabetic treatment for chronic, and Lung Cancer for catastrophic. When we'd present to student committees. They understood this comparison better than a dry review of the various plan components.

[@josephwhittington3873]

Thank you! I'm a mental health therapist and have just opened a practice. Learning through brute force about insurance is painful, but you helped me understand a lot

[@healthcaremadesimple5367]

Glad to be able to assist a bit

[@Charlestonbeachlife]

thanks for breaking this down in an intelligent, concise manner. I just got a insurance sales job with GoHealth here in Charlotte, NC and am currently trying to pass the NC Health exam to get certified.

[@healthcaremadesimple5367]

Happy I can help Dan!

[@shabbirnasir]

shabbirhealth.blogspot.com/2022/08/getting-to-grips-with-hormone-health.html

[@nextgen7105]

Every other developed nation has a universal healcare system. Insurance is clearly a scam, but at least you can learn how to get screwed a little less.

[@nadakhalid3504]

I was looking for an Arabic video to learn about medical insurance (because this is my primary language), but your video explains it very well. Thank you.

[@jorgecajas832]

I speak Spanish and EXCELLENT thanks Joe

[@hugofrutos9692]

Just got into the business, this was a great breakdown! Tks!!

[@humbleprogress1226]

Best explanation i've seen of this. Thank you.

[@healthcaremadesimple5367]

Thanks!

[@seanhorton925]

You explained this very well. Thank you

[@ResortUSF]

Helped me going into 2024 Nice video man.

[@jazminealonzo2172]

Glad I came across this video! I recently ruptured my eardrum with just a week before losing my insurance currently doing some shopping for new coverage and having you explain the different terms that I didn’t understand! I feel a lot more comfortable and what to choose! Thanks so much’

[@tomdurkins]

So in other words the broken arm would of cost a fraction of what it cost with insurance. For example, if the person with the broken arm had insurance for the last 10 years at a cost of $45,000 (120 months X $375per month = $45,000) and then broke his arm for an out of pocket cost of $4400 for a total cost of $49,400 with insurance ( $45,000+ $4400 = $49,400) . The cost of the broken arm without insurance would of been $10,000. Savings of almost $40,000 without insurance. Now watch how the defenders of insurance profits try to tear this basic fact of insurance being a scam apart.

[@HawkMoonIGOTIT]

I lost brain cells reading this you owe me some back lol

[@tomdurkins]

@@HawkMoonIGOTIT Thinking does that to low IQ people.

[@philipjdry1234]

The years of having insurance will be greater than just paying for the broken arm yourself when it happens but people don't save up for emergencies. I think it should be a tax so everyone can go to the doctor whenever

[@tomdurkins]

@@HawkMoonIGOTIT That’s because the media and big companies shut most of your brain off for you.

[@pmaint1]

​@@philipjdry1234That's called socialism! No thanks!

[@Jrswazy585]

Thank you for this video !! Out of pocket is 🔑 I was looking at the a deductible of $1000 vs $2000 although the 2000 was 1k higher but it came with less oop & 10% less co insurance

[@healthcaremadesimple5367]

You got it man!

[@josidaka20]

Great video, thanks so much. For it. I do have a question Does pt has to pay out of pocket for every physician visit until out of pocket max is paid? Or only the copay is needed to be collected?

[@michellecrockett4627]

Thank you so much I am studying for my insurance license and this really help me to understand coinsurance

[@calmingselfremedies8066]

not related comment but im really into an insurance but how you perauade is how i see myself😇

[@maryjoyariata8145]

Omg thank god you've got the best explanation ❤❤❤

[@MrUben564]

So once you hit max OOP everything going forward is covered?

[@brayanbracero5633]

Yes, 100% covered by your health insurance as long as the service is covered of your plan.

[@NovaValentine000]

Na, you still have to pay the copay. Haha. You pay again for your insurance, despite paying for it already. Lol

[@Gibson-md9yi]

Over the past 5 years between my company and myself paid close to 20k in premiums to insurance company barely used 2 k worth of it the company paid probably 350 dollars of my claims the last 4 yrs

[@Gibson-md9yi]

My company puts 500 into this a yr that has paid for all my health claims not the insurance company

[@CarolynLDean]

A good explanation! Thank you :)

[@timburge9166]

so if you crack ur arm before ur deductible is paid and pay the rest of it after you’re injured do u still get 20-80% or whatever off??

[@beautybrainsbrawn]

How does one calculate the write off amount from a deductible or coinsurance? Is it the right question?

[@healthcaremadesimple5367]

I have no idea what you mean here

[@vishnu57121]

As per website patient's deductible is $1200 and he met $400, his Out Of Pocket is $5000 and met $2500, patient is covered at 65% & co-pay is $200?. Select the right order. a. Deductible = $600, OOP = $2500, Co-ins = 25% & Co-pay = $200 Select one: b. Deductible = $800, OOP = $2500, Co-ins = 25% & Co-pay = $200 c. Deductible = $800, OOP = $2000, Co-ins = 35% & Co-pay = $200 d. Deductible = $800, OOP = $2500, Co-ins = 35% & Co-pay = $200

[@Madhav2512]

I don't know nothing before seeing this video but i got some idea after seeing the video such as co-insurance deductable out of pocket expenses. Thanq so much bro ...👍

[@healthcaremadesimple5367]

Happy to help!

[@abigailrobidoux]

I am a bit confused on when payments start to go toward the OOP Max. I have a few hundred toward deductible but a slightly higher amount toward the OOP Max (based on my portal). I thought payments don’t go toward OOP until after the deductible is met? 😊 so it’s deductible+oop that would be the total? We are having our first baby so wanted to investigate, your video is very helpful. My OB started to collect payments last year, with a total of my deductible. So that once I have baby, my payments are instantly applied to meet this years deductible. Not sure if that’s common but it’s seems helpful. 😊

[@awesomelife3680]

I think health insurance is a scam.deductibles are thousands of dollars if you pay only $200 per month. (Car payment) on top of that you still pay a fee for everything. Ive heard about health systems in denmark and canada where things are cheaper. For example seeing an specialist is always free, no stupid deductibles.

[@shredhed7719]

So you rack up a million dollar medical bill and only have to pay $6000 instead of being in debt for the rest of your life but you consider that a scam? And as for Canada, most people die before getting treatment. Good luck waiting five years for a cancer diagnosis… every single Canadian I’ve talked to hates the Canadian medical system. Canada sucks.

[@BradBrock-r6j]

How is it possible to meet out of pocket max but not deductible? I've met my max but still owe $76.69 deductible. Now for a procedure I'm told I have to pay the $76.69

[@acorntree404]

How does it work if the Deductible is higher than the Out of pocket? So 5k deductible but 2500 out of pocket? That would suggest you cant pay above 2500?

[@healthcaremadesimple5367]

That would not be possible. If a plan is listed like that, it means that the deductilbe is $5000 and then their is an additional out of pocket fo $2500. So the max OOP would actually be $7500

[@donnazamora8760]

Working in an insurance company so here I am watching this 😅

[@austinben4524]

In which?

[@donnazamora8760]

@@austinben4524 United Health Care ❤

[@zunigaca]

Thank you for example and breakdown. I get it now !

[@lTheRealKJl]

I have Aetna and got vision they take $2.47 out of every check. That’s $59.04 a year. And my deductible is $1,500. Let’s say I go for a checkup and it comes to $40. Does Aetna pay that $40 or do I have to pay $40 until I reach $1,500. It’s all so so confusing.

[@lTheRealKJl]

And if the answer is; I have to pay the $40. Does $40 comes out of the insurance? Or do I have to make sure I have $40 in my bank to or $40 in cash to pay it?

[@josuegomez3352]

What an amazing video. Thank you

[@awi363786]

You didn't mention NY, New york in your states. Does it mean you won't be able to help the client from ny, i would to like to contact you if you do. THANKS

[@cubanblanco5009]

Wow glad I have kiaser my broken arm was literally free besides $25 co pay and $10 x ray. Whewww

[@tonygareth221]

I don’t go to the doctor much but I’m going to start going more (chiropractic, check ups, etc) but I don’t know which one to choose! I’ve had the BCBS 1500 plan but should I have 750 plan?

[@mr.t8123]

Crazy,, its actually cheaper to have no insurance,,, there are places that offer great discounts if you are paying cash.. well, here in NY that is...

[@healthcaremadesimple5367]

NY is typically extremely difficult for insurance rates, and because they are so highly regulated, they do not allow many alternative options for coverage

[@RoyRahebKhelo]

How is the deductible determined? Is it calculated depending on you total bill cost, or is a pre-set fixed number that you pay regardless of your total bill cost? So, in this example was the deductible calculated to 3,000 in light of the 20,000 bill, or is the 3,000 deductible a set number that doesn't change regardless of the bill?

[@healthcaremadesimple5367]

Deductible is set by the plan itself

[@RoyRahebKhelo]

@@healthcaremadesimple5367 thank you for the reply and video. Everything made sense.

[@eastbayivxx510]

What happens if you max out the OUT OF POCKET? What happens then?

[@kendrahughes8622]

Joe, can you help me find a health insurance plan for my family?

[@mornepetersen7003]

very clear explanation. thanks

[@healthcaremadesimple5367]

No problem

[@Michael-jo9jz]

Is a $200 deductable, 80% Coinsurance, and $1,000 out of pocket maximum ok insurance?

[@healthcaremadesimple5367]

That is unbeatabale coverage

[@SakthiVel-dz7sw]

Is there is a plan like this?

[@turtlemun]

Thank you for this!

[@mikerodriguez6761]

What if your first medical bill is higher than your Max OOP. Do you just pay your OOP and the insurance covers the rest? I have a major 3 part mri this month and money is tight.

[@sdowning533]

VERY helpful. Maybe you should be the head of the health care market place because they can explain ANYTHING. I think dental is the same but, quick video may be helpful if its different. Again, thank you.

[@healthcaremadesimple5367]

Appreciate the kind words

[@officialgrindr]

I'm shopping as we speak, and the coinsurance number that I'm seeing on the marketplace right now isn't detailed as both parts of the whole 100% (for instance 80/20%). Instead they're just shown as one number, 40% for example. This would be the percentage that I (not my insurance) pay right? Because I'm seeing a lot of Out of Network visits are listed as "100% coinsurance after deductible". I can't imagine an OON visit would be free

[@healthcaremadesimple5367]

Hey Ken apologies for the delay. The deductible will likely be MUCH higher out of network which is the reason why they say 100% after deductible. As far as 40% coinsurance, the 40% is YOUR repsonsibility and the insurance company pays 60%

[@lcamp626]

How would this work if you are using someone out of network and you have a PPO that allows you to see other doctors that are out of network?

[@healthcaremadesimple5367]

Depends on the plan honestly. Usually if you go out of network, the deductible could double or triple. Additionally, if you receive a copay for going in network, it will be much more expensive to see that doctor out of network

[@pankajnaidu8967]

At the time of training i really needed this knowledge to handle Florida blue patients information that is first priority to keep it safe and to get self explanatory for the sake of knowledge from your video itself.......And thanks sir for this nice video and basically I'm from India 🇮🇳♥️🇺🇲🤝

[@natashaharvey9929]

If oop is met and plan still shows ded remaining, should we consider 100percent coverage and ignore the ded ?

[@healthcaremadesimple5367]

If you meet your max out of pocket you should be 100% covered after that

[@kimle6383]

Hi, thanks for the video. I have a question. So using this situation, if the person has another 10k bill, he only needs to pay the remaining 1.6k OOP? And the rest will be covered by insurance? Thanks

[@healthcaremadesimple5367]

You got it!

[@rudeman9514]

Thank you this video was helpful you explained everything perfect . Simple and informative

[@healthcaremadesimple5367]

You're welcome!

[@javierstambullian6843]

Hi, if anyone is watching this video pls help me. What happens if the med bill is less than mi deductible?

[@mercyloicy]

Perfect explanation Joe. 🙏

[@rbraga92]

Had a surgery and couple visits which I already met my $6000 maximum out of pocket with. Ended up having another 3 say stay at the hospital for $50,000 due to complications. I shouldn't have to pay any of this due to reaching my max oop?

[@xXDannySilvaXx]

so how did it go?

[@scarletteorchid]

I have had 2 "in-network" procedures with thousands out of pocket and my summary does not count any of it toward my deductible or max. I'm looking at a 3rd surgery in a few months. I have tried to get answers as to why I still lack almost the entire amount and get the runaround. Is there a reason they wouldn't count health-related, in-network surgeries when my coverage says it should?

[@jasmineharris08]

Maybe there should be an authorization before having a specific procedure.

[@pikachuuprising637]

Do health insurances give you the option to pay those out of pocket expenses over time or do you have to pay them up front?

[@fantomlimb5008]

So I may not exactly know what I'm talking about... but I believe you are paying the hospital / doctors office for any remaining expenses insurance doesnt pay. With that said, it would then depend on the facility whether or not they do payment plans.

[@user-ux3tz1te9x]

Joe ! Please give their definition as well and speak slowly. Actually in an interview, the interviewers ask the definition of Deductible, Copay, coinsurance, out of pocket, plan maximum, Medicare, medicaid etc. Sometimes they put questions for pointer, modifiers, units, grand father plan. Health plan data base. Please explain them one by one for your viewers.

[@myraloullusala4477]

what is a customary charge?

[@eddiew2325]

it means a charge made by the customer

[@bbibek1]

In the same example will you plz explain the role of co-pay ??

[@healthcaremadesimple5367]

I plan on making some more videos soon!

[@panky1234]

Exactly what I was searching

[@bbibek1]

thank you sir..

[@AllysonGolden-g7c]

so your co insurance payments go toward your max out of pocket? and are they paid upfront at time of services?

[@healthcaremadesimple5367]

Yes anything you spend in a given year accrues towards the plans max OOP.

[@bryanspicer90]

A major medical maximum of 500 000 means?

[@miguemigue2577]

Literally you have to break your arm go to ER pay deductible and max oop, then break your other arm during the same year so the insurance can start paying for the whole bill, otherwise you will be throwing free money to health insurance companies, because you basically pay for almost everything for the first broken arm, but if something very bad happen to you you will be lucky to have insurance if not you could end up with hundreds and thousands of dollars in debt

[@vanderson5226]

Thank you

[@millicentowens3435]

Thanks for making this simple

[@healthcaremadesimple5367]

My pleasure 😊

[@christiemcpeters3604]

Great video! Thanks for sharing.

[@m.m971]

Thanks a lot. Keep it up

[@nyamoitaratemo9130]

Health care should be free...

[@rexyz5875]

This is great

[@snigdhamithun2119]

Good joe

[@كاشفالمنافقين-ف1ظ]

Strange system and too expensive

[@sergiourias4788]

Thanks for your video

[@healthcaremadesimple5367]

No problem!

[@karyndonyell5973]

Great video, thank you so much!!

[@healthcaremadesimple5367]

Glad it was helpful!

[@irfanullahussaini9080]

Thanks from india

[@leepinnguin9682]

I wonder if you still take calls, I just tried.

[@healthcaremadesimple5367]

I do take calls Lee. Was a very busy week last week - please reach out again

[@leepinnguin9682]

@@healthcaremadesimple5367 Well, I have a new plan now but thanks anyway. I tried to channel what you were teaching into my new choice. I really appreciate the video.

[@Americana-ec]

Just amputate the arm. Health insurance stresses me out I'd rather die. But that's probably my ptsd talking

[@deepikar5862]

Why I feel like .. from one end u look like Chris Evans

[@healthcaremadesimple5367]

Only difference is I have much more muscle than he does!

[@deepikar5862]

Incredible and good to know 😁

[@travisvodden6845]

use a lav or boom microphone please

[@kathynunez2318]

Thought I'd also add this was a great explanation. Thank you! I will be sharing

[@sir.lytes1997]

U never really explained the out of pocket max

[@rudrapatel3950]

Anyone try calling the number in 2024?

[@umeshdaiah5086]

I think Coinsurance is calculated on the allowed amount.

[@NoyNoy-jt2rk]

Handsome🥰

[@RohanKumar-ss4ny]

Country code for Joe

[@RohanKumar-ss4ny]

Can I get Ur country code

[@jasonstephenson9959]

you put your phone number on youtube!? BOLD MOVE

[@jhamdan2012]

Very cute

[@irenegriego2446]

It is a scam

[@marichamyr5500]

Tamil

[@mirekhudak804]

Stop swaying back and forth, you're getting me motion sick.

[@zemogener0]

I feel like I should call Joe. I’m feeling some type of way 🫦