This is the first year of which we didn’t use a HDHP since I’m expecting a surgery. My spouse are I are under my plan (just covering two people in the plan, no children no extra dependents, just us) with the following account summary:
My individual Deductible: $600
My Out of Pocket Maximum: $2,000
Family Deductible: $1,250
Spouse’s Deductible: $600
Spouse’s Out of Pocket Maximum: $2,000
Family Out of Pocket Maximum: $5,000
Now I have two questions:
- I have a small surgery coming up which I should be able to fill my individual out of pocket maximum of 2k. So since I’ve paid to my individual maximum, would that also count towards the family deductible? Or only the portion that’s after my individual inducible counts?
- I was under the impression that the family out of pocket maximum is the individual out of pocket maximum x the number of covered people, is that not the case? And the math isn’t adding up, since we each have a OOPM of 2k, so it is possible that we both reach our individual out of pocket, but not the family out of pocket, what happens then?
- Add on to this, it seems to be the case for dec as well. We have an individual deductible of 600, but the family deductible is 1250…which I’m a bit confused about. But I guess I can make sense of this a bid more since in my case, I may be able to fill the family deductible individually (if I understand it correctly, see question 1). But I can’t make sense of the family out of pocket, since out of pocket max means..that’s the max. We each have a OoPM of 2k, is there even a scenario where we’ll have to pay more than 4k?
submitted by /u/openlyEncrypted
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This is the first year of which we didn’t use a HDHP since I’m expecting a surgery. My spouse are I are under my plan (just covering two people in the plan, no children no extra dependents, just us) with the following account summary: My individual Deductible: $600 My Out of Pocket Maximum: $2,000 Family Deductible: $1,250 Spouse’s Deductible: $600 Spouse’s Out of Pocket Maximum: $2,000 Family Out of Pocket Maximum: $5,000 Now I have two questions:
I have a small surgery coming up which I should be able to fill my individual out of pocket maximum of 2k. So since I’ve paid to my individual maximum, would that also count towards the family deductible? Or only the portion that’s after my individual inducible counts? I was under the impression that the family out of pocket maximum is the individual out of pocket maximum x the number of covered people, is that not the case? And the math isn’t adding up, since we each have a OOPM of 2k, so it is possible that we both reach our individual out of pocket, but not the family out of pocket, what happens then?
Add on to this, it seems to be the case for dec as well. We have an individual deductible of 600, but the family deductible is 1250…which I’m a bit confused about. But I guess I can make sense of this a bid more since in my case, I may be able to fill the family deductible individually (if I understand it correctly, see question 1). But I can’t make sense of the family out of pocket, since out of pocket max means..that’s the max. We each have a OoPM of 2k, is there even a scenario where we’ll have to pay more than 4k?
submitted by /u/openlyEncrypted [link] [comments]Read Morer/HealthInsurance