I have been working for a new company for a year now, and have been on their insurance through Aetna the entire time. It’s the first time I’ve had health insurance through work.. So I’m paying monthly out of my check for the health insurance, but then im still going to owe my health provider out of pocket at the end of the year if i don’t pile up enough medical bills?
In: Economics
As mentioned in other replies, it varies a lot from plan to plan, but basically:
Premium: this is what is deducted from your paycheck regardless of whether you need medical care or not.
Deductible: This is the amount you just pay out of pocket before insurance provides any coverage. It’s cumulative for the plan year so if you have a $1000 deductible and you get a medical bill for $800 you would pay the whole bill yourself. Then if later that year you got a second bill for $700 you would only have to pay $200 to reach $1000 total before coverage kicks in.
Coverage: This is SUPER plan specific, but this is the % insurance pays of the bill, often 80%. Some things are covered more, some are covered less.
Out of pocket maximum: If you’re having a particular bad health year, this is the maximum you would pay (again cumulative) in a year, at which point insurance covers 100% of costs (that are specified in your individual plan)
But of course we make it even more complicated because some items like preventative care are fully covered without a deductible as are some tests and screenings depending on your plan, and there’s a whole seperate set of rules for care providers that don’t participate in your insurance plan and the need or lack thereof for pre approval and referrals that are again, plan dependent.
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