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@ladycpd Meeting your deductible does not mean that everything you receive after is covered at 100% unless your plan also has a 500 out of pocket max. Even then- it has to be medically necessary, non-excluded and in network.

@kylie26 It means you don't have to hit a certain threshold (your deductible) before you pay coinsurance. If you look at most medical plans, each service is usually a copay or coinsurance percentage. (IE- 20% after the deductible or 20%, deductible does not apply). If you have a zero dollar...

@rignoid What state are you in? You're correct that healthcare.gov is no longer an option on account of "voluntarily" losing COBRA and your loss of coverage prior to then was a year ago. If you "lost" coverage (aka last paid for COBRA) In february, then it's too late to get on your work's...

@tim_mcf HSAs are individually owned. So if the HSA is in your spouses' name and he only has the HDHP plan, He can continue with the family HSA contribution limit with no issues.

@aaron5 Good Evening, Unfortunately, "affordability" is calculated by the least expensive plan available to you by your employer and the "employee only" rate. If the Employee only rate of the least expensive plan (even if that's not the plan you're choosing) is 8.39% or less, then you did have...

@allaneparker I mean businesses can refuse service, but it seems odd for them not to accept self-pay. It's not fraud to accept a patient if you don't take their insurance though- that piece they have wrong. Now, it may be against their agreement with certain insurances to accept self-pay from...

@emmalynx Look on your EOB- Explanation of Benefits- from your insurance. You'll see a "network discount" or "allowable amount" listed--- this will reflect any automatic network discount you're getting. Sometimes it shows the actual allowable amount, sometimes it just shows the amount they...

@vladimirsurguy Yeah, that 70% means the plan will cover 70% of what the insurer feels is the allowable amount for that service. With in-network, those providers agree to the allowable amounts as a maximum. Out of network the providers don't have to agree to that and can then balance bill you...

@eddiebeltran If you have insurance now that you will lose when you go back to school: COBRA is an option Healthcare.gov is also an option Your school may offer insurance as well

@qzxcvbn It looks like Claims 1,2 and 3 are the "physician" bills- so The Electro, the ER visit and the X-ray--- paying the tech/nurse/doctor for their services and the 4th bill is all of the care you got while at the ER- the ACTUAL X-ray, the ACTUAL Electrocardiogram--- It's not a...

@nikki1104 You not using the coverage doesn't matter- you did not cancel the coverage and you had it available IF you had needed it. Covered CA is not going to retro terminate your coverage back to 2023 if you failed to terminate your coverage and/or update your income. You're going to owe that...

@pjfl Through your job? Yes, You should be able to get a California plan. It just may not be good in Florida- it depends on the network of the California plan(s) you're being offered. You'd run into trouble if you didn't move your residency to California and wanted a Covered CA (Cali's...

@dontajohnson This is the question everyone asks- which is "better" for me. If you fear that paying the full contracted rates until you meet your deductible- as in a $150 doctor visit would be devastating/hard vs a $5 copay... then I think plan B works better for you. Now, if you already...

@vanpotheos So- a zero dollar deductible, just means you don't have to meet a deductible before you start the coinsurance. So, based on your plan document posted--- If it was a $10,000 ER visit that was a true emergency- that benefit is showing that you'd pay a $200 copay and then the rest...

@vanpotheos Are we looking for the best financial deal? Two ways to look at it: First method is adding the deductible to the annual premiums and then subtracting any EMPLOYER contributions to an HSA, FSA or HRA. This will give you the max financial liability for all in-network, medically...

@okieallday Unless your plan has a separate Ded/OOPM for pharmacy or other services (rare, but it happens) you can assume it's all care- medical and pharmacy. You have to check and see if the family deductible is aggregate or embedded. Aggregate means you have to meet the full Family...

@mountaintrip98 See, that's what I'm thinking too--- a lot of people assume that "covered" means paid at 100%... it just means the member meets eligibility for the procedure based on their medical condition "medically necessary" and the plan pays in accordance to the payment details-- and for...

@peruss Ahhh, well... I'm trying to rack my brain as to why insurance would send a Prior Auth stating they'd cover $4500... as that's not typically how things work--- they don't say "this is approved and we'll cover $4500". They either approve the procedure or deny it--- and it's paid in...

@peruss If you paid $4500 and insurance covered 1199.27, you can seek reimbursement for the 1199.27 from your provider.

@aletia I second this. MANY of my clients who are all HR professionals tell me "I don't love benefits because I just don't understand them" and I think if you had an employee benefits background, that is a MAJOR selling point to get hired in HR. Now, that assumes you LIKE benefits too. P&C is...