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What is your copay for doctor/pediatrician visit?


momacacia
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Are the premiums on these plans really high?

 

Ours is a high deductible plan (we pay 100% up to 6000, then pay 80/20 to $8000). My DH's employer does give him a traditional insurance option, but the outrageous premiums  mean the high deductible plan would be far smarter financially for all or nearly all.

 

I feel frustrated sometimes because my husband and I tend to avoid the doctor when we shouldn't, for ourselves, not the kids, due to the high costs. Our insurance gets worse every year, and DH is in a state employee pool--its really huge.

 

I've been wondering this myself. I've been thinking that our insurance is pretty darn good for the past few years. Until this December, when our insurance changed for the worse AND when I had to work with my mom quoting a 150 or so therapy clients on what to expect to pay for their 2017 visits. Now I'm depressed about our insurance :(

 

We have a $4,000 family deductible ($6,500 family OOP maximum). After that, we have a co-insurance of 20% for all services except for preventive care (which is free). This is costing us about $400 a month. 

 

On the upside, the company gave us $1,000 in an HSA, and we (thankfully) had enough funds available to drop another $3,000 in the HSA, so we're covered up to the deductible. And this plan is cheaper than our old plan was, so we can count that extra $70 a month toward the high deductible/OOP max. 

Edited by ILiveInFlipFlops
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Are the premiums on these plans really high?

 

No, iirc somewhere between $100 and $150/month for our family of 4. That said, my wife's employer pays a crazy amount for our health insurance per year - her salary is so-so, but the health insurance is pretty good.

 

One free well-check per person per year, $25 copays for doctors of any kind* as well as for urgent care, no referrals needed, the ER would probably use up all or most of our deductible in one fell swoop though. I'm not 100% sure it's still the case, but psychologist visits used to be free, with only 10 or 20 appointments allowed in a year per person, though after that number has been reached the psychologist can write a thing saying more appointments are required... never gotten to that number. Now, if only the HSA money would all roll over, it'd be great.

 

*ETA: in network. Doctors out of network cost more.

Edited by luuknam
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We have a $6000 deductible with a $13,500 out of pocket. (It pays 80% in between)

 

This is our only employer offered option. I thought all companies were going towards this, but a friend (federal employee) was recently complaining about her $350 deductible, so I guess not.

 

we pay about $400 a month. I am not sure how much the employer pays for their part of the premiums.

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Wellchecks free

$35 co-pay

The county also has a free clinic for it's employees & family, for simple illnesses, labs, etc we can go there. I can also get some prescriptions free there (Alegra & flonase are 2 for example) It does help to save, the county my dh works for self-insures, so it helps them save $$.

Edited by Prairie~Phlox
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What are average copays for well child or sick child visit if one has fairly good health insurance (not a high deductible)? Just curious.

 

I have a great Kaiser Permanente Plan. Well-checks and annual physicals for adults are free. Lab work and shots are free. Sick visits are $20.

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Are the premiums on these plans really high?

 

Ours is a high deductible plan (we pay 100% up to 6000, then pay 80/20 to $8000). My DH's employer does give him a traditional insurance option, but the outrageous premiums  mean the high deductible plan would be far smarter financially for all or nearly all.

 

I feel frustrated sometimes because my husband and I tend to avoid the doctor when we shouldn't, for ourselves, not the kids, due to the high costs. Our insurance gets worse every year, and DH is in a state employee pool--its really huge.

 

Not too bad no.  $380 per month for 4 people.  Deductible is $500 per person or up to $1500 for the family.  Copays are $20 (as I said).  Except ER copay is $100.  Walk in is $20.  Surgery and inpatient is $250.  Some stuff has a coninsurance.  Many services are not subject to the deductible.  All services have at least a copay though (even well visits, vaccines, etc.).  Can't really complain about that though.

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Well checks are included unless they do anything else. Sick visits are OOP until deductible is met. There's a family practice clinic you can use that's totally covered including lab work, but it's for physicals, check ups, and minor illnesses. No x-ray machine or anything like that. Glorified doc in the box, but we do really like the physician there!

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Zero for well child or well adult. Pretty sure that's a requirement by law.

 

All other visits, we pay 100% until meeting family deductible, and then 20% until meeting individual or family out of pocket (whichever comes first).

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Ouch! How many people are in your family?

 

There are 3 of us and yes, it's insanely expensive. We had a Bronze level plan from the exchange last year, which would be about $200 less per month, but we'd have a large deductible and out of pocket limit and every visit (except wellness visits) would be subject to the deductible. 

 

It's our largest bill by far (mortgage is next and is $700/month including property taxes and insurance) and I stress about paying it every month. But if one of us gets ill and needs the insurance, I'll be grateful that we have it. I regularly want to move an hour north and live in Quebec. 

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$30 for regular doctor and mental health

$40 for specialists

$200 for ER

We pay nearly a thousand a month for our premiums (employer provided), and still have an a frustratingly high deductible to meet. I'm still thankful to have insurance!

 

I do miss our last few insurances. Co-pays were similar, but we paid very little for premiums (also employer provided) and deductibles.

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Pre-ACA: $20 for primary care and $30 for specialist after the $500 deductible. Max OOP was $1.5k

 

Currently: 10% for anything after the $4.5k deductible with max OOP of $6,850 (the silver lining is the deductible counts towards the max) :cursing:

 

We do have a choice of Kaiser HMO with a smaller deductible and OOP max and that's what we had from 2013-2015 but Kaiser denied my daughter cochlear implant surgery so we switched for 2016. We just found out that she's now a candidate for the 2nd ear so it's a good thing that we kept the PPO plan for 2017. We might consider switching back to Kaiser for 2018 if she has the 2nd surgery this year.

 

ETA: The cochlear implant surgery was $125k plus there was several thousand more for the pre-surgery evaluation and post-surgery programming of the implant. It's too bad that she was not eligible to have both ears done at the same time since that would've cut down on the costs for both us and the insurer. But she was a borderline candidate even in the worse ear last spring (that's why Kaiser denied it).

Edited by Crimson Wife
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