Finding affordable health insurance in Ohio is a challenge, but you will see many choices on our website. That's the easy part. But what about the deductible and copay? Which one is best? Is it wise to select a higher amount and save money or play it safe with lower options. We'll help you understand the differences in Metal plans and explain which deductible or copay works best for you.
The deductible is the the amount that you are responsible for before a large claim is paid. An example is the hospital bill following a surgery or accident. But depending on the type of policy you have, you will not have to meet this amount for covered prescriptions and office visits. So, hypothetically, if you are extremely healthy and rarely have large medical claims, you might never use or meet your deductible.
Therefore, a higher amount may make financial sense. For a family of four, in many parts of the state, a private plan from SummaCare, Ambetter, or Medical Mutual will cost about $2000 less per year by increasing the deductible from $2,500 to $6,000 (or higher).
This savings can increase to as much as $2,500 to $3,500 if the deductible is increased from $1,500 to $5,000 or $7,150. And of course, an HSA (get details here) should always be considered. Over a 10-year period, a family can easily save about $20,000 in premiums. Unless you have multiple major medical problems, you'll easily pay less.
Are there risks? Yes. Just like your auto insurance, when you increase your collision and/or comprehensive deductibles and you will have to pay more if you have an accident that is your fault, your health insurance in Ohio works the same way. It's great to save money but it's not very economical to pay an extra $2,500 a few years in a row.
Negotiated Network Discounts
Since many hospitals and medical facilities will "bargain" with you, regarding an outstanding obligation, we continue to encourage the use of higher out-of-pocket expense limits. For example, often a hospital will agree to accept a lesser amount, and also allow you to pay the balance in monthly installments. Generally, up to 60 months is available, with the approval of the hospital. Other medical facilities, such as Urgent Care centers, surgical centers, and physician's offices, may not be as accommodating.
In the previous hospital scenario, you can utilize the few hundred dollars of savings each month and simply pay that to the hospital. Each facility operates independently, and their billing and write-off procedures would have to be discussed directly with them, and not the insurer. HSA deposits may be available for this type of arrangement, assuming the medical expenses are qualified.
For example, let's assume you had a major hospital stay (Miami Valley Hospital in Dayton, Ohio State University Wexner Medical Center, or Fairview Hospital) as a result of a heart attack, and the accompanying surgeries, procedures, treatment etc... and the outstanding bill was $250,000. Also included were specialist, room, anesthesia, and facility charges.
Your insurer would negotiate the amount down to approximately $175,000 and your out-of-pocket portion might be $5,000. It's also possible that the $5,000 could be negotiated down to $3,000-$4,000. Thus, of the original $250,000 obligation, $3,000 is your responsibility. And you may be able to pay that amount in installments.
Office Visit Copays
The copay, which is usually between $15 and $40, is the amount that you pay out of your own pocket for an office visit to your physician or specialist. Sometimes the specialist copay is higher, often reaching $50. Of course, if you have a "high deductible" or "catastrophic" policy, there may not be any copay since you would have to pay most of the bill (minus a negotiated discount).
Although it's not often a popular suggestion, I strongly urge you to select higher options. Why? A $10 copay is obviously better and less costly than the $30 amount. You save $20 every time you visit your primary care physician or a specialist. Don't forget that preventive visits don't require a copay. Sounds great. But is it?
Suppose you use the copay five times per year (although many of you will not reach that amount). That's a savings of $100 per year. But your premium is likely to increase approximately $200-$250 for selecting the least costly option. If you have a family policy, you may pay as much as $500-$1,000 more. It is not cost-effective to select the lowest available copays, unless it is a group plan through work and you simply have no other alternatives.
If you are the only person covered on your policy, higher amounts should always be selected. By raising your portion of the office visit expense from $15 to $30, you'll easily save $100 to $150 per year. And certainly, you're not going to have 7-10 visits per year (on average). If a $50 option is available and you rarely utilize this portion of the policy...take the option!
Important caveat: I have been referring to personal individual and family health insurance plans because they tend to be very flexible. You own them and you can make changes, subject to the approval of the insurer. If you are presently covered under a group plan, you may not have the luxury of being able to make changes to your coverage. What you have may be what you're stuck with, although there may be a few different types of policies to choose from.