Help Explain Health Care Coverage for Me

[iiinycboi]

so i am a agency owner and i have to buy health care for myself.

the broker doesnt really explain it well and i dont deal with health side.

i am looking at a NY HMO plan, it shows

in-network co-payment - 30/50 500/day IP Hospital

does this mean i have to pay 500 dollars per day if i stay in the hospital or it is a 500 dollar benefit only and i pay for the rest.

Also they tell me i have a 1200 deductible is this for medical services only? or hospital in patient care? so confusing this health care stuff....

then i got a pharmacy deductible 100 but a rider for 15/35/75

all for 500 bucks a month, please help explain! thank you!

 

[Josh]

Why not get a broker that will explain it to you?

 

[iiinycboi]

oh i plan to lol, but i just want to know before hand so i know im not getting a half right answer

just wanna be better informed.

 

[arnguy]

Why not get a broker that will explain it to you?

That is an excellent idea!!!!!

 

[leevena]

so i am a agency owner and i have to buy health care for myself.

the broker doesnt really explain it well and i dont deal with health side.

i am looking at a NY HMO plan, it shows

in-network co-payment - 30/50 500/day IP Hospital

does this mean i have to pay 500 dollars per day if i stay in the hospital or it is a 500 dollar benefit only and i pay for the rest.

Also they tell me i have a 1200 deductible is this for medical services only? or hospital in patient care? so confusing this health care stuff....

then i got a pharmacy deductible 100 but a rider for 15/35/75

all for 500 bucks a month, please help explain! thank you!

I cannot be 100% sure of this answer because of limited information provided.

$500 per day IP--Usually means $500 per day payment for the IP costs from you, but you need to look closer at the wording and see if there is a limit, such as "$500 per day to a maximum of X" or to the stop-loss limits.

$1200 for Medical Services--Usually means the amount you would pay for "non-inpatient hospital expenses" that you incur.

RX usually means you pay the first $100 you pay, then you pay only the copay amounts.

30/50 appears to be the office visit copay for pcp/specialist.

Example-you go to hospital for 2 days, hospital charge is $4000 and your medical services (doctor, etc) is $2,000. Your hospital oop is $1,000 IP deductible (2 days at $500 per day) plus the $1200 deductible on the $4000 medical services, for a total oop of $2200.

 

[iiinycboi]

ahh makes sense, but why i have to pay 500 dollars to goto the hospital =(

the wording is 500 per day to a max of 1000 per continuous confinement

and 100 dollars for RX first? how much do they usually cost? i thought it would be like 5-12 dollars per bottle for standard stuff.

i had no idea health care was so expensive

 

[leevena]

ahh makes sense, but why i have to pay 500 dollars to goto the hospital =(

the wording is 500 per day to a max of 1000 per continuous confinement

and 100 dollars for RX first? how much do they usually cost? i thought it would be like 5-12 dollars per bottle for standard stuff.

i had no idea health care was so expensive

For every dollar you pay, the cost goes down. RX is very expensive, which is why dedutibles have become common. Costs are much higher than 5-12 bucks.

Health care is very expensive to begin with, but in NY with community rating and GI it gets even more costly.