My insurance has a $7,000 deductible.. what is the point? NY

I was on Medicaid when I made $20,000 ish a year and it was amazing. I got a new job this year and I believe my annual income will be around $30,000 now and I have lost Medicaid. I looked around for another option but they were all around $300 a month, so I opted for my work insurance which is $100 a month but $7,000 deductible. I rarely use it so assumed it would be fine, but an emergency happened and I had to have bloodwork done. So now if I understand it correctly, I pay out of pocket up to $7,000? That’s kind of crazy especially when I pay monthly, what is really the point?

@jarkody I’ve got a $7000 deductible on mine too but I make a bit more ($50k annual) and also formerly on Medicaid. It’s pretty terrible situation but there are still advantages to being insured, like negotiated rates for network doctors, and usually plans have a lot of preventative stuff covered, like a physical, routine screenings.

But if you’re struggling to pay your medical bills, ask the provider for a payment plan. I think changes to credit reporting happened recently for medical debt under $500 can not be reported on credit reports, but for the most part, get on a payment plan or it can mess up your credit. When I was on Medicaid, I had a $500 ER visit that I couldn’t pay and made the mistake of stopping my small payments on it, went to collections and messed up my credit for the next 7 years.

@froglace it’s worth asking if they will give you a discount if you pay cash! i learned that one this week actually

@froglace Thank you for the information, I appreciate it!

@jarkody The point is that you don't pay more than 7,000 (assuming everything is covered after that). Otherwise, hospital bills can easily be 50,000 for certain situations, or more.

@froglace Was this long ago? I thought medical debt doesn’t affect credit anymore?

@slk I think that change is rather recent. My experience was around 2016 I think

@slk It gets removed when paid or settled. It does not linger on credit reports anymore.

@jarkody Essential Plan goes up to $29K and has a $2K max OOP and a $0 premium. Next year it goes up to $36.5K, 2K max OOP, and $15 premium over the $29K level.

https://info.nystateofhealth.ny.gov/sites/default/files/NY 1332 Waiver Application_5.12.2023.pdf

@korvus Is the $15 premium for over 29k current or only next year?

@jarkody Starts in 2024 if it goes through, which it almost certainly will. The Federal government need to approve the waiver. NYS passed the change last year.

@jarkody Depending on policy and tests blood work may be covered. We have high deductibles but most routine lab work is covered. We pay copays for doctors. It’s confusing for sure. As your MD office/lab/hospital etc for an estimated cost. Shop around if it’s not emergent.

@malvoc Thank you! Hopefully part of it is covered.

@jarkody Yeah, depending on your provider, they may even have an online cost estimator that you can check out. But, in general, don't agree to any procedure or test without first getting a code for that test so you can call member services and run it past the provider's billing/benefits dept to get your true cost. And obviously do everything you can in network because that will be cheaper. I have a high deductible too and while it stinks (I got a skin rash that may need to be tested so I get it), you still have to manage it as best you can, for example I had a blood test recently for another skin issue and the next doctor was able to use that test because it wasn't but a few weeks prior, so I lucked out on that. You can also stock up all your concerns and try to handle them all when you get your free annual physical, which as someone said does allow some testing, but still check those testing costs too before you get them. And do your best to make more to pay more for a Silver plan, up from a Bronze, because you're seeing how it might bankrupt you should you get sick. If you're mostly healthy Bronze can work but not when surprise illnesses hit. Good luck.

@taylorhudson89 If a patient brings up any questions or concerns during an office visit it is no longer preventative and instead becomes problem focused and would either hit cost sharing or be full cost member responsibility toward deductible.

@silverback My PCPs have never done that to me.