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. 11 Vinny Catalano: Deductibles Demystified
Listen to Vinny's Hot Health Takes as he demystifies your health plan deductibles in about three minutes!
Depending on how your insurance plan is structured, your deductible could play an important role alongside your out of pocket maximum.
Your deductible is the amount of money you would pay for your (covered) health care before your insurance starts to pay ("you pay first").
Usually the only thing that is not subject to your deductible is your annual physical (and some blood tests that your doctor would do in a annual physical).
Keep an eye on your available deductibles 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 wellbeing,
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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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Hey, good morning.
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We most recently talked about the magic number in a health plan,
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which is the annual out-of-pocket maximum.
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Today we're just going to talk about deductibles.
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Now,
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if I say that word,
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I guarantee if I had a little magic wand in front of me doing this,
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I said the word deductible,
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you'd probably fall asleep.
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But the point of a deductible is,
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you know,
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it's the you pay first of a health plan,
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which means depending upon that health plan,
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the way that health plan is structured,
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the deductible plays an important role.
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If you're in a standard plan that has a copay to go see the doctor,
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that deductible may not kick in until you receive certain types of services like
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going to the hospital or imaging or other things.
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But if you're in a high deductible plan or a consumer-directed health plan,
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that could be connected to a health savings account, that deductible starts from $0.
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Meaning you go to the doctor, you're not going to pay a $20 copay.
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You're likely to pay a $200 visit to see that doctor.
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Now,
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that deductible,
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again,
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how the plan is structured,
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could be,
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say,
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a couple thousand dollars.
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And then once you've hit that deductible,
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you have this thing called coinsurance beyond it until you hit the annual
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out-of-pocket maximum.
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Some plans, like the one I'm on, the deductible actually equals the out-of-pocket maximum.
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So my wife and I have a plan with a family $14,000 deductible.
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And basically, you have to hit that $14,000 before the insurance kicks in.
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But at the same time,
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if we hit that $14,000,
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we'll be out of pocket $0 for the rest of the year.
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The only thing that's not subject to the deductible is your annual physical.
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So you're allowed to go see your physician for an annual physical plus
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some blood work.
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So certain blood tests like cholesterol and a few others,
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glucose,
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are covered annually without being subject to the deductible.
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In some of the more traditional plans,
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there also may be a separate pharmacy deductible for your brand name medications.
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So be mindful of this.
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The deductible isn't a mystery.
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It's just what the you pay first is, depending upon the plan design that you're on.
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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
