CLEARly Beneficial Podcast
CLEARly Beneficial Podcast: Where We Rip Off the Band-aid and Explore What's Next
Welcome to the CLEARly Beneficial podcast - the show where we rip off the band-aid on healthcare and explore the future of benefits with the people driving innovation in our industry.
Host Vinny Catalano brings over 20 years of health insurance brokerage expertise to conversations that get to the real story. You'll discover what actually works, what doesn't, and what's coming next from the innovators brave enough to challenge how we've always done things.
Whether you're an insurance broker navigating carrier politics, an HR professional trying to make sense of complex plan designs, or an employer seeking practical solutions for your people, this podcast delivers the straight talk and actionable insights you need.
We rip off the bandage and give you the inside perspective that only comes from decades in the trenches. Ready to see what's really happening in healthcare? Let's explore the future together.
CLEARly Beneficial Podcast
Ep. 10 Vinny Catalano: Your Health Plan's Magic Numbers
The most important thing in picking out an insurance plan is...
Your maximum out of pocket!
All of your costs related to your health will be stacked up against that maximum out of pocket before your insurance covers it. In other words, all the other things under your insurance plan: the deductible, the coinsurance, the copay, etc, all apply to that out-of-pocket maximum. Once you hit that maximum, it caps the amount of money that you will be spending in that calendar year.
Keep an eye out for it next open enrollment!
Disclaimer: This content is for educational purposes only. Please discuss your specific situation with your health benefits administrator or insurance provider for personalized guidance.
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Welcome to the Clearly Beneficial podcast,
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the show where we rip off the Band-Aid and explore the future of healthcare,
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benefits,
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and the people driving innovation in the industry.
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This episode is brought to you by Health Next,
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the company leading the way in helping employers build enduring cultures of health
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and well-being,
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reducing medical cost trends,
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and increasing organizational performance.
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To learn more how they can help you, visit healthnext.com.
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Happy Monday, everybody, and everybody's in the throes of making decisions for open enrollment.
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So I wanted to chime in on what is the most important number when it comes to a health plan.
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Everybody worries about the copay,
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they worry about the coinsurance,
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and they worry about that dreaded term,
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guaranteed to make you fall asleep, called the deductible.
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But neither of those three things are the most important function of a health plan.
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The most important function of a health plan is the maximum out of pocket.
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So the annual maximum out of pocket.
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So you'll find it on any plan summary, and it's the thing you ignore.
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You don't even know why it's there.
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So why it's there is the only reason you actually have health insurance.
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It's there because it's the thing that caps the amount of money that you will be
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spending in a calendar year if the shit hits the fan.
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And so the bottom line is you buy insurance to protect your out-of-pocket risk.
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All the other things under that, the deductible, the coinsurance, the copay, all add up.
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to that out-of-pocket maximum.
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So when you go to the doctor,
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you pay the deductible,
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that adds up to the,
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that applies to the out-of-pocket maximum.
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The copay generally applies to the out-of-pocket maximum.
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The coinsurance applies to the out-of-pocket maximum.
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But that's the number if you look at it,
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and it's depending on the plan,
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if you're on a commercial plan with an employer,
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that number could actually be quite reasonable.
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It could be 3,000 a year,
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4,000 a year for an individual,
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twice that usually for a family or a plus one.
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In the ACA plans, you're only going to see that kind of plan design in a platinum level plan.
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Usually the bronze, silver, and golds all have pretty high annual out-of-pocket maximums.
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I was just doing a renewal this morning for my wife's company,
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and I noticed actually ours came down a titch this year,
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but it's still basically 7,000 for a single and 14,000 for the two of us combined.
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So the ACA plans tend to have higher out-of-pocket maximums.
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The commercial plans tend to have lower out-of-pocket maximums,
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but that's the number you should be worried about when it comes to a health plan.
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So the two things you worry about, really, the out-of-pocket max and the premium.
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That's the amount of money you're going to pay every month for that plan.
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So just wanted to chime in real quick so you knew what the magic number actually is
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and something to pay attention to as you're making decisions this year for your
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health insurance open enrollment.
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this podcast reflects the personal views of the host and guests not their employers
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or sponsors see you next time.
