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If you have HC insurance what is your annual out of pocket maximum?

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slipslidingaway Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Jun-30-10 09:11 PM
Original message
If you have HC insurance what is your annual out of pocket maximum?
Ours is over 11,000 and that differs from the annual deductible which is about 2500.





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Bitwit1234 Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Jun-30-10 09:16 PM
Response to Original message
1. Zero
what with Medicare and BC/BS I don't pay anything out of pocket except 4 or 5 dollars for prescriptions.
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Donnachaidh Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Jun-30-10 09:18 PM
Response to Reply #1
3. so how do you get free bc/bs?
???
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notadmblnd Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Jun-30-10 09:41 PM
Response to Reply #3
16. I pay zero for mine too. However, it doesn't cover office visits
Needless to say, we don't run to the Dr. for every sniffle or fart that doesn't feel right. How we got it is; my husband's union negotiated with his company for those benefits and they are provided to the employees family and survivors. yeah, I know, unions are worthless :sarcasm:
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madmom Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Jul-01-10 08:59 AM
Response to Reply #16
55. This is the same with us, BUT, if your are like many others, your union
negotiated and concessions were given to get this insurance so in reality it is/was not free.
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slipslidingaway Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Jun-30-10 09:25 PM
Response to Reply #1
8. Sounds good :) n/t
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Nite Owl Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Jun-30-10 09:17 PM
Response to Original message
2. $612 a month for premiums
$20 copays. No deductibles if you go to the PPO doctors, which is almost everyone where I live. This is for one person, not family. Family plan is double. If you go out of the plan I think the deductible is about $700.
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slipslidingaway Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Jun-30-10 09:31 PM
Response to Reply #2
9. We pay premiums as well, it is the annual out of pocket that could...
really hurt, different from the annual deductible. We're looking at a procedure that is 250K plus and then follow up treatment each year, nice way to take an 11K cut in income. Fortunately the policy has no maximum benefit as some policies do and happy to have something at this point.









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daylan b Donating Member (392 posts) Send PM | Profile | Ignore Wed Jun-30-10 09:20 PM
Response to Original message
4. $7,500 on an HSA
But my deductible is $7,500 as well. It's basically just a combination catastrophic insurance policy and regular health care discount club we pay $300/month to take part in.
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slipslidingaway Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Jun-30-10 09:32 PM
Response to Reply #4
10. Thanks :) n/t
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Oregone Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Jun-30-10 09:23 PM
Response to Original message
5. I don't pay anything out of pocket for medical care
Edited on Wed Jun-30-10 09:26 PM by Oregone
No deductible, no co-pay, $116 a month premiums for entire family coverage

My out-of-pocket on pharma drugs is income based (4% of income max)

Oh Canada...
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slipslidingaway Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Jun-30-10 09:34 PM
Response to Reply #5
11. But you are all coming to the US or lining up on street corners ...
for care.

;-)

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Oregone Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Jun-30-10 09:35 PM
Response to Reply #11
12. Im one of the few running from the US
When I was self-employed in the states, I paid as much for a single visit as I do now all year.
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slipslidingaway Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Jun-30-10 09:53 PM
Response to Reply #12
23. Smart move. n/t
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Oregone Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Jun-30-10 09:57 PM
Response to Reply #23
26. Not really. The US made a first step to be fixed later, big fuckn deal reform
Its a lot to uproot a family when we will get universal single payer health care in 76 years if we stayed.
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slipslidingaway Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Jun-30-10 10:36 PM
Response to Reply #26
35. Not that we have done it, but I can imagine that it is a big deal...
to move your family to another country, but at least you do not have to go bankrupt.



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Oregone Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Jun-30-10 10:38 PM
Response to Reply #35
36. One of the many reasons
Its a great place to raise kids too. :)

Definitely makes life difficult in some respects
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slipslidingaway Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Jun-30-10 11:31 PM
Response to Reply #36
44. Kids, so often a large part of our decisions ...
and yes one still has to leave other family members behind ... tough decision.



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Uben Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Jun-30-10 09:23 PM
Response to Original message
6. $10K max out of pocket
...that comes with a $5K deductible and I pay 50% of the next $10K. After that, it pays all.

Even a crappy policy like this is costing $20K/yr in premiums for someone who has had cancer.
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slipslidingaway Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Jun-30-10 09:39 PM
Response to Reply #6
14. That could really hurt, after 11,000 most everything is covered...
but we'll see. My husband was diagnosed with MDS in April, so we are looking at a bone marrow transplant if everything goes well these next few months, hoping we need to pay 11,000 each year for a long time.

Best to you and yours :)





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rurallib Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Jun-30-10 09:24 PM
Response to Original message
7. My wife has medicare + bc/bs + drug coverage
I think her premiums are @ 2500/yr. But she pays very little out of pocket except her drug deductible.
but mine is something else. @5000/yr in premiums and a $5000 deductible. They don't pay shit. So I sit here feeling like crap, wishing I could afford to see a doctor.

You can't imagine how I felt that night that Lieberman said he was OK with moving Medicare down to age 60. And then how I felt when he changed his mind.
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slipslidingaway Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Jun-30-10 09:42 PM
Response to Reply #7
17. It will be interesting to see what happens when more people have ...
insurance but are still not able to pay the out of pocket expenses, I wish we had pushed for a not for profit system :(

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rurallib Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Jul-01-10 07:58 AM
Response to Reply #17
52. I wish, wish, wish Obama would have started negotiations from a
universal single payer system. He negotiated with himself to insurance reform.
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Lisa0825 Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Jun-30-10 09:37 PM
Response to Original message
13. Out of pocket max for employee only is $1,750
This includes deductible ($250), but not copays.
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slipslidingaway Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Jun-30-10 09:44 PM
Response to Reply #13
19. That is great, is there a maximum lifetime benefit? Some policies have ...
a lower annual out of pocket maximum, but then have a lifetime max of say 1 million?

Thanks :)



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Lisa0825 Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Jun-30-10 09:53 PM
Response to Reply #19
22. I am looking at the plan summary, and I do not see any mention of lifetime max....
but I am not sure.

It is one of the best plans around, though. I work for a major teaching hospital, and they self-insure but have it administered through BCBS.
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slipslidingaway Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Jun-30-10 09:56 PM
Response to Reply #22
24. Well it is something to check on and stay healthy ...
and get the yearly check ups!



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Lisa0825 Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Jun-30-10 10:01 PM
Response to Reply #24
28. I'm pretty good about going to the doc.... the dentist is another story!!!
:scared:
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slipslidingaway Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Jun-30-10 10:32 PM
Response to Reply #28
33. LOL ...
dentist appt. in the a.m. for me.



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handmade34 Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Jun-30-10 09:41 PM
Response to Original message
15. this question is not directed at me
since I have no health care coverage and I have no intention of needing any :yoiks: so therefore I pay nothing, but...

this question should make us all incredulous at the serious discrepancy between what people pay / don't pay.
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slipslidingaway Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Jun-30-10 09:51 PM
Response to Reply #15
21. I hope you do not need any as well! A few years ago our annual
deductible increased, guess we never paid attention to the annual out of pocket, but we are now. The NIH can be a good free resource, we almost went there, but then we would have to move to the area for a few months.



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handmade34 Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Jun-30-10 10:31 PM
Response to Reply #21
32. Best wishes to you and your family
I do not know much about MDS but my brother has been diagnosed with a form of leukemia and has talked about offering himself as part of a study for new drug (as he has little coverage) My work is for the CDC (HHS and NIH) and while they offer BC/BS my premiums when I was covering my kids was approx. $16,000/year and BC/BS still made me jump hoops and denied claims, and as we had very few I was disgusted and on principle refuse to participate in a corrupt system.

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slipslidingaway Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Jun-30-10 11:27 PM
Response to Reply #32
43. Thanks and best wishes to your brother as well ...
MDS can progress to acute myeloid leukemia, something we are trying to avoid. My husband is currently on a trial of decitabine and tretinoin with the goal being a bone marrow transplant in September, so far one of his brothers looks like a good match.

http://clinicaltrials.gov/ct2/show/NCT00382200

We had contacted the NIH and they are very accommodating and all medical care is absolutely free, even if your brother just goes there for tests and another opinion it may be helpful. One of my cousins knows two people who are in remission after being treated at the NIH. Another resource that might come in handy for accommodations while being is the American Cancer Centers Hope Lodge, the closest one that I know of to the NIH is in Baltimore. We stayed at the one in NYC last week and it was a great experience...well of course we would have preferred being home :)

http://www5.cancer.org/docroot/subsite/hopelodge/md_bal...

Good luck and please PM me if you have any questions, although my knowledge is limited in this area, I'll be happy to share what I've learned. Yes, dealing with the bills is enough to make one sick.

:hug:



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Coyote_Bandit Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Jun-30-10 09:43 PM
Response to Original message
18. Ummmm......
I am a non-smoker and have no documented pre-existing conditions.

Annual premium is just under $4,000.

Annual deductible is $10,000.

There is a 20% co-pay beyond the deductible.

Doctor visits are not covered.

Small wonder I haven't seen a fucking doctor in over 15 years.

Somehow I doubt that will change - unless catastrophic causing death or severe dysfunction happens.

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slipslidingaway Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Jun-30-10 09:58 PM
Response to Reply #18
27. Diseases can be caught early, but only if you have the check ups...
Edited on Wed Jun-30-10 09:59 PM by slipslidingaway
please do not wait for something catastrophic.


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Coyote_Bandit Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Jun-30-10 10:35 PM
Response to Reply #27
34. Good advice but
somebody has to pay the frickin bill for that preventative healthcare. I ain't made of money and there ain't nobody jumping up and down to make those payments on my behalf.

I'm approaching 50, overeducated, long-term unemployed, single, and have no prospects for employment. Since I lived frugally and saved some $$$ I do have some assets. I'll have to liquidate virtually all of them before I qualify for any kind of assistance. Or I can gamble my life savings to start a business and create my own job. But there is no assistance in that endeavor and the frickin government has insured that most of the competitive advantages go to large businesses.

In this fucking country healthcare is a luxury. Apparently so are jobs.

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slipslidingaway Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Jun-30-10 10:45 PM
Response to Reply #34
37. Even with health insurance, health care is still a luxury ...
and that is a sad statement, the HC bill does nothing to help people who have these high out pocket expenses.

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Coyote_Bandit Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Jun-30-10 10:56 PM
Response to Reply #37
40. You're right
Thank you for acknowledging it.

So many want to pretend otherwise.
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slipslidingaway Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Jun-30-10 11:44 PM
Response to Reply #40
48. No pretending from me ...
but if you can splurge for your 50th, a full physical with a good internist might be a good idea, rather boring I know.

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ClaireF Donating Member (11 posts) Send PM | Profile | Ignore Wed Jun-30-10 09:47 PM
Response to Original message
20. $3100 oop maximum with an HSA
$1550.00 deductible with a $500 annual employer contribution to my hsa.
My monthly premium is $15.00.
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slipslidingaway Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Jun-30-10 10:29 PM
Response to Reply #20
31. Sounds good, just check the annual out of pocket and ...
welcome to DU, belatedly :)

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USArmyParatrooper Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Jun-30-10 09:56 PM
Response to Original message
25. $0.00
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slipslidingaway Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Jun-30-10 10:55 PM
Response to Reply #25
39. Great! ...
we just met someone last week who recently had a bone marrow transplant who was or is in the army, his email came back with "us.army.mil"

Question, is that only for active duty soldiers? TIA and stay well!





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USArmyParatrooper Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Jun-30-10 10:59 PM
Response to Reply #39
41. That's his AKO email
And yes, that's for active duty troopers.
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slipslidingaway Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Jun-30-10 11:36 PM
Response to Reply #41
45. Thanks ...
he did not say he was in the army when we met him, but we plan on keeping in touch.

Appreciate the reply :)







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Mimosa Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Jun-30-10 10:09 PM
Response to Original message
29. $10,000 each, annually, 70/30 plan, $850 a month for 2 people
Edited on Wed Jun-30-10 10:10 PM by Mimosa



For about 25 years my partner has been self employed. For most of that time Blue cross Blue Shield of LA, then after Katrina, GA, has been our provider.

Our premiums have gone up so high that in an effort to keep them affordable so we could remain insured we'd let them raise our deductible.It is now $10,000 a person on a 70/30 in network plan with co-pays for doctor visits, lab tests and Rxs. For this we are now paying $850+ a month!
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slipslidingaway Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Jun-30-10 11:00 PM
Response to Reply #29
42. No wonder so many people have filed for bankruptcy even when ...
they have insurance :(



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Mimosa Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Jul-01-10 05:09 AM
Response to Reply #42
49. We fear losing our house if we got sick...
But then if we got sick we couldn't afford the darned premiums...so... *head spinning* :dilemma:
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slipslidingaway Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Jul-01-10 11:08 PM
Response to Reply #49
58. Sadly, that has been the American way for too many people. n/t
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ejpoeta Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Jun-30-10 10:12 PM
Response to Original message
30. currently we are on the state plan which hs a $5 copay. but before that
and if we hadn't qualified for the state plan, we would be 'enjoying' a $5000 deductible PER PERSON before they even shelled out a dime. UHC all the way. and after that it would be 80/20. the kids have been on child health plus. and they did away with independent health which was expensive, but didn't have these deductible bs. just the copay and the tiered pharma. but that's gone. and all that is left is the plan where you pay a lot every month just so that they don't have to shell out a dime unless you get really sick.
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slipslidingaway Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Jun-30-10 11:38 PM
Response to Reply #30
46. So many people will find out they cannot afford to use the ...
insurance ... it really is a crime.

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blueamy66 Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Jun-30-10 10:49 PM
Response to Original message
38. $2400
Edited on Wed Jun-30-10 10:50 PM by blueamy66
for one female....$15 copays....okay, I guess, these days...

on edit....I just posted my premiums...oop is $1000
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slipslidingaway Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Jun-30-10 11:40 PM
Response to Reply #38
47. If the out of pocket is 1000 then that is very good ...
as people always said, you find out how good your insurance is when you really need it.



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quaker bill Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Jul-01-10 05:55 AM
Response to Original message
50. $6,000
for the family. However, brutal past experience indicates that is 6K in "covered" expenses. For things not covered, the sky is the limit. I have found that one can be under the routine and normal care of a typical doctor at an "in plan" hospital, and still run up a quite considerable number of "uncovered" expenses.
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blueamy66 Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Jul-01-10 08:44 AM
Response to Reply #50
54. Yeah, like the ER doc
Edited on Thu Jul-01-10 08:44 AM by blueamy66
who doesn't accept BCBS. WTF?2

We experienced this last year. What a nightmare. If one goes to an in network ER, one's ER doc should accept one's insurance.
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quaker bill Donating Member (1000+ posts) Send PM | Profile | Ignore Fri Jul-02-10 08:18 PM
Response to Reply #54
60. BCBSFL here
and yes, you have that right.
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SoCalDem Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Jul-01-10 05:57 AM
Response to Original message
51. Don;t know.. the premiums are deducted, and my husband pays $20 copays
when he goes to the dr., and it costs about $200 every 90 days for his diabetes/heart meds.. I don't go to the dr. or take any meds.

When I did have eye surgery it cost $0 out-of-pocket, and I pay $20 every year for the opthalmologist appt.
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tinymontgomery Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Jul-01-10 08:24 AM
Response to Original message
53. Tricare
Tricare Prime as a military retiree. $460 a year, $12 co-pay and various prescription costs.
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rusty fender Donating Member (442 posts) Send PM | Profile | Ignore Thu Jul-01-10 09:47 AM
Response to Original message
56. $2,000 for one person
I'm at $600+ so far this year. I'm not sick, but doctors insisted I have a bunch of "let's rule cancer out" tests. I knew I did not have cancer, but I went along with them because someday I might actually need them, and didn't want to be unco-operative.
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Doremus Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Jul-01-10 09:53 AM
Response to Original message
57. No out of pocket maximum. $775/mo premium, $25 copays, 80/20 coverage
Our out-of-pocket averages $15K/year.
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slipslidingaway Donating Member (1000+ posts) Send PM | Profile | Ignore Fri Jul-02-10 08:39 PM
Response to Reply #57
63. Many people would be bankrupt if they needed to pay 15K in addition to premiums...
sadly many too many people who have insurance did just that.

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slipslidingaway Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Jul-01-10 11:10 PM
Response to Original message
59. Thanks everyone for the replies :))) n/t
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NNN0LHI Donating Member (1000+ posts) Send PM | Profile | Ignore Fri Jul-02-10 08:23 PM
Response to Original message
61. Less than a thousand dollars a year combined for my wife and I
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slipslidingaway Donating Member (1000+ posts) Send PM | Profile | Ignore Fri Jul-02-10 08:38 PM
Response to Reply #61
62. That is your annual out of pocket maximum or your annual deductible...
Edited on Fri Jul-02-10 08:41 PM by slipslidingaway
if it is the max out of pocket then you are lucky, as long as your policy does not have a maximum lifetime cap.



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NNN0LHI Donating Member (1000+ posts) Send PM | Profile | Ignore Fri Jul-02-10 08:53 PM
Response to Reply #62
65. Thats my approximate total annual out of pocket maximum including my annual deductible
Edited on Fri Jul-02-10 08:54 PM by NNN0LHI
There is no maximum lifetime cap.

Also have $1700.00 worth of dental coverage per year for each of us. And a vision plan that isn't too bad.

Don
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slipslidingaway Donating Member (1000+ posts) Send PM | Profile | Ignore Sat Jul-03-10 12:45 AM
Response to Reply #65
66. That is great! n/t
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NNN0LHI Donating Member (1000+ posts) Send PM | Profile | Ignore Sat Jul-03-10 06:03 AM
Response to Reply #66
67. That used to be the standard that most companies went by just 30 years ago
That is when unions were strong in the US. Now we have non-union companies setting the pattern for these kinds of benefits for everyone.

Getting screwed by employers is what we are left with now.

Mission Accomplished!

Don
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slipslidingaway Donating Member (1000+ posts) Send PM | Profile | Ignore Sat Jul-03-10 10:59 AM
Response to Reply #67
68. So true, our policy has changed drastically over the last several...
years...and not for the better :(

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hack89 Donating Member (1000+ posts) Send PM | Profile | Ignore Fri Jul-02-10 08:47 PM
Response to Original message
64. About a $1000. nt
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