Question about insurance deductible

[disneyfreakk]

Hi, my DH just got new insurance through his employer that went into effect 10/01/13. Our plan is grandfathered in, so I think we will be able to keep it even with ACA in effect.

My question is this, we have $1,000 individual deductible with a $3,000 family deductible. It is just the two of us, no kids, and I am on his plan. How will our deductible be processed? will he have to meet his 1,000 and I meet my $1,000 or will we have to pay the $3,000 deductible before any out of pocket is considered, even if only one of us needs to meet the deductible?

This is the first time in our marriage that we don't have individual health plans, so I am unsure.

Thanks in advance!
DF

 

[Shelly F - Ohio]

Since you have a family plan even though its just the two of you, your total family deductible will be $3000. You both will contribute jointly to the $3000 deductible.

The $1000 individual deductible written in your policy is only applicable to those who have individual coverage EI: a plan that only has one person listed on the policy. Such as the plan you and DH use to have

 

[disneyfreakk]

That's what I was afraid of. Thanks for the quick answer!

 

[mhsjax]

Since you have a family plan even though its just the two of you, your total family deductible will be $3000. You both will contribute jointly to the $3000 deductible.

The $1000 individual deductible written in your policy is only applicable to those who have individual coverage EI: a plan that only has one person listed on the policy. Such as the plan you and DH use to have

I thought that if you meet your $1000.00 then after that your insurance paid on your claims, but if your spouse hadn't then the ded would apply to them. The #3000.00 is a cap and even if you have more than 3 people in your family the max ded would only be $3000.00

Yep I just checked. each person has a $1000.00 deductible, one person A has paid this amount, insurance will start to pay. Person B still has to meet their $1000.00 ded before the insurance will pay. If you have kids later on and lets say you have 2 kids. the total deductible you will pay is $3000.00 not $4000.00 which would be $1000.00 each. The family dec is like putting a cap on how much dec you actually have to pay. It has nothing to do with only one person being on the insurance policy. At least not for mine and others that I looked up.

 

[disneyfreakk]

I thought that if you meet your $1000.00 then after that your insurance paid on your claims, but if your spouse hadn't then the ded would apply to them. The #3000.00 is a cap and even if you have more than 3 people in your family the max ded would only be $3000.00

Yep I just checked. each person has a $1000.00 deductible, one person A has paid this amount, insurance will start to pay. Person B still has to meet their $1000.00 ded before the insurance will pay. If you have kids later on and lets say you have 2 kids. the total deductible you will pay is $3000.00 not $4000.00 which would be $1000.00 each. The family dec is like putting a cap on how much dec you actually have to pay. It has nothing to do with only one person being on the insurance policy. At least not for mine and others that I looked up.

Thank you for taking the time to look it up, I wasn't sure where to find that info on the internet!

I was REALLY hoping that our insurance would work out the way you explained it!

 

[clh2]

Really - you need to check the info that pertains to the policy that you have.

The plan I am on at work is very, very, very specific as to the "family" deductible cost. Ours is a "combined-family" deductible.

I don't like the plan - but the reality is -we made the best choice for our family - and we have more in our HSA to cover 2-years of the total out of pocket cost for the high deductibles, and out of pocket co-pays.

 

[mhsjax]

Really - you need to check the info that pertains to the policy that you have.

The plan I am on at work is very, very, very specific as to the "family" deductible cost. Ours is a "combined-family" deductible.

I don't like the plan - but the reality is -we made the best choice for our family - and we have more in our HSA to cover 2-years of the total out of pocket cost for the high deductibles, and out of pocket co-pays.

Yes, exactly. Plans can be very tricky.

 

[mhsjax]

Thank you for taking the time to look it up, I wasn't sure where to find that info on the internet!

I was REALLY hoping that our insurance would work out the way you explained it!

YOu are welcome, but as someone posted, please check your plan. They can be very tricky.

 

[lauradis]

Really - you need to check the info that pertains to the policy that you have.

The plan I am on at work is very, very, very specific as to the "family" deductible cost. Ours is a "combined-family" deductible.

I don't like the plan - but the reality is -we made the best choice for our family - and we have more in our HSA to cover 2-years of the total out of pocket cost for the high deductibles, and out of pocket co-pays.

Get customer service number. Write down all questions you have. Ask away, your their customer they should explain it to you.

 

[marius97]

I thought that if you meet your $1000.00 then after that your insurance paid on your claims, but if your spouse hadn't then the ded would apply to them. The #3000.00 is a cap and even if you have more than 3 people in your family the max ded would only be $3000.00

Yep I just checked. each person has a $1000.00 deductible, one person A has paid this amount, insurance will start to pay. Person B still has to meet their $1000.00 ded before the insurance will pay. If you have kids later on and lets say you have 2 kids. the total deductible you will pay is $3000.00 not $4000.00 which would be $1000.00 each. The family dec is like putting a cap on how much dec you actually have to pay. It has nothing to do with only one person being on the insurance policy. At least not for mine and others that I looked up.

My family's plan works the same way. Once one person hits their personal deductible, then anything after that is paid. I've never heard of it the other way...That being said, call your insurance company for a full and accurate explanation.

 

[elgerber]

My family's plan works the same way. Once one person hits their personal deductible, then anything after that is paid. I've never heard of it the other way...That being said, call your insurance company for a full and accurate explanation.

Mine does not work that way, I am on my third high deductible plan, and they have all worked the same. Because we have mulitple people on the plan, we have to meet the family deductible before anything kicks in.

 

[amcnj]

As suggested above call your plan to make sure, but in general the way you described it each person has $1000 deuctible, but the entire family will pay no more than $3000. Since there are only two of you on the plan now, then the most you should pay is $2000, if you both need that much care in a year. Some plans have other options, like Employee/Partner too, not just single versus family, but I am assuming your plan just had the two options as that is all you mentioned.

 

[kkandaj]

Here is how our plan works:

DH, DD and DS all have a $600 deductible--EACH of them.

When DS meets his $600, insurance starts paying for HIS additional medical bills at 90%. DD and DH still have to meet their deductible of $600 each, UNLESS, we pay $1500 out of pocket, which is the family deductible.

If two of them meet their deductible at $600 each, ($1200 total) we would still pay 10% for the last $300 until the $1500 is met. THEN insurance would pay 100% of all claims for each family member, even the one that didn't meet their deductible. Does that make sense?

Of course, check your own plan. I am on my work's insurance by myself and it works exactly like this at my work also. DH covers himself and the kids.

 

[GAGirlInVA]

I thought that if you meet your $1000.00 then after that your insurance paid on your claims, but if your spouse hadn't then the ded would apply to them. The #3000.00 is a cap and even if you have more than 3 people in your family the max ded would only be $3000.00

Yep I just checked. each person has a $1000.00 deductible, one person A has paid this amount, insurance will start to pay. Person B still has to meet their $1000.00 ded before the insurance will pay. If you have kids later on and lets say you have 2 kids. the total deductible you will pay is $3000.00 not $4000.00 which would be $1000.00 each. The family dec is like putting a cap on how much dec you actually have to pay. It has nothing to do with only one person being on the insurance policy. At least not for mine and others that I looked up.

This is how ours works.

 

[ceecee]

You need to meet your $1000 ded and then the insurance will pay. Your DH will have to meet his $1000 and the $3000 means it caps off if you would have kids on your plan. So the max ded you would pay would be $3000 since it is just the two of you, it will be $2000.

 

[clanmcculloch]

It depends on the plan. At my work we had the option of 2 different types of plans.

Plan A: $600 per person deductible, $1300 family deductible = this means that the maximum deductible for the family is $1300 but for an individual it won't be more than $600. My 13yo hit the $600 deductible by the end of January. DH just did last month. My 15yo and I between the 2 of us haven't paid that additional $100 combined in deductible. DH and DD13 only get charged copays at this point while DD15 and I if we had medical expenses would be charged a deductible up to that $100 that brings us to the family total of $1300 then we'd only get charged copays. If there was only 2 of us on the plan instead of a family then our max would be $1200, $600 each.

Plan B: $1000 individual deductible, $3000 family deductible = if you have an individual plan then the first $1000 has to be satisfied then it's just copays. If you have a couple or family plan then you have to pay $3000 regardless of whose bills then it's just copays after that for everybody.

 

[arihillfarm]

Is there an option of a "self+one" policy vs. a standard family policy? It seems strange that you would have a $1,000 per person individual deductible but a $3000 family deductible when you are the only two insureds on the policy.

-Astrid