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?
My insurance has a $7,000 deductible.. what is the point? NY
- Thread starter jarkody
- Start date
@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.
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.
nikole1015
New member
criches111
New member
@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
https://info.nystateofhealth.ny.gov/sites/default/files/NY 1332 Waiver Application_5.12.2023.pdf
taylorhudson89
New member
@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.
silverback
New member
@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.
taylorhudson89
New member
@silverback My PCPs have never done that to me.
@taylorhudson89 Most do as a practice, especially within integrated health systems. If your primary cannot perform, they’ll refer you elsewhere within system, which also will go beyond routine physical. Think, “would you like fries and drink with that.” It’s a business and they’re selling. Good luck! 
@jarkody Often even if you end up needing to pay a few grand out of pocket, as the premiums are so much cheaper with a high deductible plan, you still come out ahead. That said, ideally your possible out of pocket costs shouldn’t be more than you are able to pay. Compare any plan options to see what is the best option next enrollment.
Note typical non emergency blood work ordered by primary care is unlikely to be over $500, could only be $100-200, or even fully covered as preventative. Depends what it is. Even if insurance makes you pay 100%, you still get their negotiated rates, often much lower than you’d be charged otherwise.
Added: Often even ER care is less $ than you’d think, can be negotiated down, put on a payment plan, etc. Many of my visits were less than $1k even with blood work and imagining. It depends on condition, location, etc, though.
In my opinion the best thing about insurance is it limits your $ liability to the out of pocket max amount. That could save you from bankruptcy if you need surgery, ICU care, etc. Plus you’ll typically get way better care versus being uninsured, in which case many doctors won’t even see you as they don’t know what to charge and/or don’t want to risk going unpaid, the ER will ensure you won’t die then kick you out (unless you put down a huge $ deposit), etc.
With my husband’s work’s plan options, even though we end up paying our $6k out of pocket max every year with my health issues, that plus the low premium paycheck deductions cost us less in total than if we had chose the “better” plan.
Note typical non emergency blood work ordered by primary care is unlikely to be over $500, could only be $100-200, or even fully covered as preventative. Depends what it is. Even if insurance makes you pay 100%, you still get their negotiated rates, often much lower than you’d be charged otherwise.
Added: Often even ER care is less $ than you’d think, can be negotiated down, put on a payment plan, etc. Many of my visits were less than $1k even with blood work and imagining. It depends on condition, location, etc, though.
In my opinion the best thing about insurance is it limits your $ liability to the out of pocket max amount. That could save you from bankruptcy if you need surgery, ICU care, etc. Plus you’ll typically get way better care versus being uninsured, in which case many doctors won’t even see you as they don’t know what to charge and/or don’t want to risk going unpaid, the ER will ensure you won’t die then kick you out (unless you put down a huge $ deposit), etc.
With my husband’s work’s plan options, even though we end up paying our $6k out of pocket max every year with my health issues, that plus the low premium paycheck deductions cost us less in total than if we had chose the “better” plan.