Finding affordable health insurance in Ohio is a challenge, but you will see many choices on our website. That’s the easy part. But what about the deductible and copay? Which one is best? Is it wise to select a higher amount and save money or play it safe with lower options. We’ll help you understand the differences between all available plans, and explain which deductible or copay works best for you.
The Deductible (under Age-65)
The deductible is the the amount that you are responsible for before a large claim is paid. An example is the hospital bill following an inpatient or outpatient surgery, accident, or ling illness. An ER visit may also have to meet a deductible. But depending on the type of policy you have, you will not have to meet this amount for covered prescriptions and office visits. Thus, if you are extremely healthy and rarely have large medical claims, you might never utilize or meet your deductible.
Therefore, a higher amount may make financial sense. For a family of four, in many parts of the state, a private plan from SummaCare, Ambetter, or Medical Mutual will cost about $2000 less per year by increasing the deductible from $2,500 to $6,000 (or higher). Currently, $8,550 is the maximum allowed deductible, although future legislation may allow increases to $10,000 (or more). $2,800 is the minimum allowed deductible for HSA plans.
This savings can increase to as much as $2,500 to $3,500 if the deductible is increased from $1,500 to $5,000 or $8,550. And of course, an HSA (get details here) should always be considered. Over a 10-year period, a family can easily save about $20,000 in premiums. Unless you have multiple major medical problems, you’ll probably pay less. Each OP period, you may change to or from the HSA and another Exchange plan.
Are there risks? Yes. Just like your auto insurance, when you increase your collision and/or comprehensive deductibles and you will have to pay more if you have an accident that is your fault, your health insurance in Ohio works the same way. It’s great to save money but it’s not very economical to pay an extra $2,500 a few years in a row. NOTE: If your medical or financial situation changes, new annual Open Enrollment periods allow you to adjust your coverage.You may select a new plan, a new carrier, and completely different deductibles, coinsurance, and copays.
The Deductible (Senior Medicare Advantage Plans)
Medigap coverage provides an economical option to substantially reduce potential out-of-pocket costs that original Medicare may not cover. Advantage contracts often cost less than Supplement plans, and may also provide additional benefits, including prescription drug coverage. It’s important to verify that your physicians, specialists, and preferred hospitals are included in the provider network. Listed below are low (or no) deductible options for several policies in the Buckeye State.
Additional coverage that should be properly compared includes the premium, maximum out-of-pocket expenses, physician and specialist copays, lab and x-ray copays, prescription benefits, Urgent Care and ER copays, and daily inpatient hospital costs. The plans shown below may not be offered in all counties, and deductibles also may vary.
$0 – Humana Gold Plus – Diabetes And Heart
$0 – UPMC for Life HMO Deductible With Rx $0 – Humana
$0 – UPMC for Life HMO Rx Enhanced
$0 – UPMC for Life HMO Rx
$0 – Aetna Medicare Choice Plan
$0 – Aetna Medicare Value
$0 – Paramount Elite Advanced Medical And Drug
$0 – Paramount Elite Standard Medical And Drug
$0 – AARP MedicareComplete Plan
$0 – AARP Medicare Advantage Walgreens
$0 – Medigold Classic Preferred
$0 – Medigold Flexible Choice
$0 – Medigold Southwest OH Essential Care
$0 – Medigold Southwest OH Classic Preferred
$0 – Medigold Southeast OH Classic Preferred
$0 – RiverLink Classic Plus Rx
$40 – Anthem MediBlue Access Enhanced
$50 – Anthem MediBlue Access
$60 – Anthem MediBlue Essential
$60 – Anthem MediBlue Plus
$100 – Prime Time Health Plan Plus
$120 – UnitedHealthcare Assisted Living Plan
$125 – Coventry Advantra Silver
$150 – Prime Time Health Plan Classic
$150 – Medigold Essential Care
$170 – AARP MedicareComplete Plan 2
$175 – Aetna Medicare Select Plan
$175 – Aetna Medicare Value Plan (Available in several deductibles)
$200 – Humana Gold Plus – (Available in several deductibles)
$200 – Medigold Southeast OH Essential Care
$200 – Prime Time Health Plan Aultimate
$200 – Aetna Medicare Standard Plan
$200 – AARP MedicareComplete Plan 4
$200 – AARP MedicareComplete Plan 1
$225 – AARP MedicareComplete Plan 7
$225 – AARP MedicareComplete Plan 8
$240 – AARP MedicareComplete Plan 5
$255 – AARP MedicareComplete Plan 6
$400 – Anthem MediBlue Dual Advantage
$400 – Reid Health Alliance Medicare HMO Rx
$400 – Reid Health Alliance Medicare HMO Rx Plus
$400 – UnitedHealthcare Dual Complete
$400 – UnitedHealthcare Nursing Home Plan
Negotiated Network Discounts
Since many hospitals and medical facilities will “bargain” with you, regarding an outstanding obligation, we continue to encourage the use of higher out-of-pocket expense limits. For example, often a hospital will agree to accept a lesser amount, and also allow you to pay the balance in monthly installments. Generally, up to 60 months is available, with the approval of the hospital. Other medical facilities, such as Urgent Care centers, surgical centers, and physician’s offices, may not be as accommodating.
In the previous hospital scenario, you can utilize the few hundred dollars of savings each month and simply pay the amount to the hospital. Each facility operates independently, and their billing and write-off procedures would have to be discussed directly with them, and not the insurer. HSA deposits may be available for this type of arrangement, assuming the medical expenses are qualified. An ongoing payment schedule may be possible.
For example, let’s assume you had a major hospital stay (Miami Valley Hospital in Dayton, Ohio State University Wexner Medical Center, or Fairview Hospital) as a result of a heart attack, and the accompanying surgeries, procedures, treatment etc… and the outstanding bill was $500,000. Also included were specialist, room, anesthesia, and facility charges.
Your insurer may negotiate the amount down to approximately $375,000 and your out-of-pocket portion might be $7,000. It’s also possible that the $7,000 could be negotiated down to $5,000. Thus, of the original $500,000 obligation, $5,000 could potentially be your responsibility. And you may be able to pay that amount in installments.
Office Visit Copays
The copay, which is usually between $10 and $50, is the amount that you pay out of your own pocket for an office visit to your physician (pcp) or specialist. Typically, the specialist copay is higher, often reaching $50- $120. If you have a “high deductible” or “catastrophic” policy, there may not be any copay since you would have to pay most of the bill (minus a negotiated discount). Specialist visits always have a higher copay and may be subject to a deductible.
Although it’s not often a popular suggestion, we strongly urge you to select higher options. Why? A $10 copay is obviously better and less costly than the $30 amount. You save $20 each primary-care physician or specialist visit. And preventive visits don’t require a copay. Sounds great. But is it?
Assume you use the copay five times per year (although many of you will not reach that amount). That’s a savings of $100 per year. But your premium is likely to increase approximately $200-$250 for selecting the least costly option. If you have a family policy, you may pay as much as $500-$1,000 more. It is not cost-effective to select the lowest available copays, unless it is a group plan through work, and you have no other alternatives.
If you are the only person covered on your policy, higher amounts should always be selected. By raising your portion of the office visit expense from $15 to $30, you’ll easily save $100 to $150 per year. And certainly, you’re not going to have 7-10 visits per year (on average). If a $50 option is available and you rarely utilize this portion of the policy…take the option, but consider other differences in the policies.
Important caveat: Personal individual and family health insurance plans tend to be very flexible. You own them and you can make changes, subject to the approval of the insurer. If you are presently covered under a group plan provided by your employer, you may not have the luxury of being able to make changes to your coverage. Although there may be several choices of plans (HSA, PPO comprehensive, and HMO comprehensive), generally, you won’t have many of the customized features provided by private coverage.