48 Comments
If you live in the United States, how would you best describe your insurance plan type and its annual medical deductible?
You must be logged in to post a comment.
© 2022 T1D Exchange. All Rights Reserved.
I have an insurance plan through my employment. In the past the individual deductible was $7,000. I changed employment in 2000 and was denied coverage at my new employer so went on my husbands plan which has individual deductibles of $3,000.
Medicare with a supplement. $203 deductible and then I pay nothing.
I have a Medicare Advantage plan through Humana, pay no premiums and no deductible (for either prescriptions or other medical). The only advantage to getting old!
Many of us, like me, are on Medicare. I chose to answer the question as individual insurance.
I have Medicare and a Medicare Supplement/Medigap policy. My Medicare Supplement/Medigap policy, Plan F, has no copays or deductible.
The Medicare Advantage plan I am on has no deductible, just co-pays. The only thing that messes up an otherwise great and affordable plan is when I reach the donut hole.
My insurance is a Medicare Advantage HMO which has copays but no deductible for A or B, only a maximum annual out of pocket payment; there is a deductible for pharmaceuticals, but it is low until one hits the donut hole (or rather, in the Republican spirit of old apartheid euphemism, the stage of part D coverage that replaced the donut hole — pass legislation abolishing the term but keep the thing in reality), but in practice coverage is fairly good even there.
Medicare advantage
Medicare with Medigap, I’m in TX so avoid the DisAdvantage Plans.
I have Medicare as primary with Federal BCBS as secondary. I have no deductible since the Federal BCBS picks up everything that Medicare does not cover. I do have a co-pay for prescriptions through Federal BCBS.
We have family insurance but our deductible is $5,000 per person for a total of $10,000. I wish I could find something that was as low as $2,800!!
Private insurance (BCBS) plan here with only ONE plan option. I pay $800 a month for my family insurance then $3000 for my deductible then my $50 co-pay then any other expenses that aren’t covered by the insurance. So, I have to pay 4 separate times for one visit for one person and this doesn’t include paying for the deductible and co-pay for each of my prescriptions!!
BCBS through my husband’s employment plan. Very high deductible, individual $10,000. Plus the $50 co-pay for Dr. visits, prescriptions, and the remaining part that insurance does not pay after my deductible is met.
Medicare and Medigap low deductible $203. Stepping off my previous employer provided insurance $750/month and $2,000 deductible, to medicare and medigap with Part D prescription coverage cut my insurance cost by more than half!
I am covered by Medicare with “gap” insurance that is a continuation of the health insurance I had before I retired. So there are two different deductibles. But a fair answer is that I enjoy a low deductible bracket, though in part because I pay a premium for a higher level of coverage with the non-Medicare health insurance.
Very thankful for what I do still have because Obamacare caused me to lose eye and dental insurance . The company where my husband worked 43 years for then retired, grandfathered him in so ins would cover spouses until spouses turn 65.
Primary coverage is through spouse’ employment with multiple high (5,000 -7,000)deductibles, 20% co-payments and 20% co-insurance charges. Medicare A & B is my secondary insurance that covers portions of the DME remaining.
I answered family plan, high deductible. But, I also have a secondary insurance that picks up deductible and co-pays required by primary insurance. I and my son pay nothing for care (except premiums on primary plan), but my husband has co-pays because he doesn’t have the secondary. He can also use the VA health system too if he choses for less.
Individual HSA (health savings account) High Deductible PPO private insurance through my employer. My annual deductible is $2,800 and annual premium is $884.52. Pharmacy is a separate copayment and the plan is 90-10, meaning after the deductible has been met, insurance pays 90% and I pay 10%. The crazy part is the difference between the charges billed and the charges allowed. My last order of 9 Dexcom G6 sensors and 2 transmitters was billed at $8,249.00, the allowed amount was $1,300.00, insurance paid $1,170.00 and I paid $130.00. Why the provider bills $6,949.00 more than the agreed upon allowed amount is either pure fantasy or industry standard marketing practice so we the consumers feel we’re not over paying.
If you’re in the US and still working I highly recommend you setup a HSA account as it’s another way to reduce your taxable income and pay your medical, dental, vision and pharmacy expenses with untaxed income and it’s yours forever.
I have medi-cal and Nedicare only .
I’m in a Medicare advantage HMO. There are co-pays, but no deductible.
I have a Medicare Advantage plan with no deductible for medical or pharmacy, it’s a PPO plan. My PCP has no copay but specialist do. It dose have vision & dental included.
I have no deductible I pay a high premium Medicare supplement I have no co-pays no deductible and all my meds for diabetes are covered under part B insulin pump supplies CGM. I chose to do it this way versus claims and paperwork just easier I worked out all the numbers and it was actually cheaper for me to go with this plan which is anthem plan F in addition to medicare.
Individual is $150 deductible. Tricare retired military insurance. I am blessed!!
I have a Medicare Advantage Plan with no deductible. It is a diabetes focused plan so no co-pays for PCP, Endo, Podiatrist,
counseling, and comes with a nurse case manager.
$6000 deductible here… I’m not sure if there’s a different one for family deductible. But, given diabetes, I always meet it and then some! =:o :p
I answered “individual” but in fact it is Medicare, and I don’t know if that is included under the “insurance” umbrella.
My health insurance is state Medicaid no deductible just copays
I have State insurance and don’t have a annual medical deductible
Medicare & supplemental insurance
Transitioning from employer based insurance to Medicare B and Medigap. Research to be done.. March 2022
My husband and I went on Medicare last year. We have traditional Medicare and a Medigap plan from AARP United Healthcare. Very happy. As a T1D, all i see is various specialists but with this insurance no referrals are needed. Whatever you do DO NOT get a Medicare Advantage plan if you can possibly avoid it.
I could not reply to Miriam’s reply so I will reply to your post. I have been on a Medicare Advantage plan for the last 15 years and have had no issues with it. The plan has worked very well for me, and for my non-diabetic wife, so I guess the answer is, you need to keep doing the research! In Ohio the State insurance website is very helpful in determining which plan is best for any individual.
After our COBRA insurance expired when I, and then later my husband, left the corporate world, we got onto our state-run insurance plan. Because of pre-existing conditions, we could not go out and shop for the “best deal” and plan for ourselves. It was a great plan, truly affordable, and efficient management of the plan.
Then the (un)Affordable Care Act went into place and even though it is run by each individual state, the premium is incredibly high. It is the best plan for me (my husband recently went on Medicare due to turning 65). My deductible is $8,250/year for just myself.
HMO
Wasn’t really sure how to answer this question. In a Medicare Advantage plan.
I have insurance through my husband. It’s self +1 with a $700 deductible or $350 each.
I have a medicare advantage plan
Medicare and Supplemental w/o drugs
Confusing, not clear to pharmacy, dependent on how Rx is written, many T1D drugs not covered at all
I said my insurance isn’t structured in this way because I don’t have a deductible.
I have Medicare and a supplemental A, B and D program with my former employer. The Medicare Part B deductible is $203. I don’t know if it went up for 2022.
Insurance through my job. Individual plan, $2,000 deductible with 30% co-insurance after that until max OOP of $7,900 is met. But none of that applies to my diabetes care (doctor visits, insulin/strips, pump supplies) which are just straight co-pays.
I am currently on my husbands’ health insurance through work. They are golden handcuffs! The medical deductible is $3000, the copay is then $2000, per person. This is now covered by our built-up health savings account. Diabetic needs are covered completely before any deductibles.
I was only on Medicare and Aid for six years during the 1990s. I still use Medicare B.
I have no deductible. I have an out of pocket max. After this is met everything is at no cost.
Is a “deductible” the same as a yearly cap on out of pocket expenses? I seldom reach that $1300? $1500? cap. Is that the doughnut hole? But I pay out of pocket at least $600/year. It’s annoying to get additional charges of $5 or $15 for lab work, or misc. stuff a month later. I don’t know if these additional piddling charges are recorded as “out of pocket” on the monthly records. I think I pay about $54/month for the cheapest Medicare “Advantage” plant. Twice turned down for pump. Only last spring did I get a CGM. Specialists and techs at KP in Seattle are usually excellent. I guess I’m paying at least $1200 per year for routine care. But if I make a trip to Urgent Care or have a really serious problem?
Medicare is not structured as described. One deductible at the beginning of the year and 1, 400 throughout the rest of the year.
Everything is taken out of Social Security.
I agree with mbulzoni
I have a Excellus Medicare PPO policy. Monthly premiums with no deductible. I am very happy with this in NY state.