What's that? How much? Isn't there usually only one deductible?
A deductible is the amount you pay for covered healthcare services and treatments before the insurance starts to pay. Private health plans will usually have only 1 deductible. More working Americans get to choose some version of a High Deductible Plan before the plan picks up the costs. The deductibles are often $1500 - $4000. Sometimes there are deductible tiers (or multiple deductibles) related to specific conditions, such as having a baby.
Medicare has 2 deductibles. One for Part A and one for Part B.
Part A (2021) - $1484
Part B (2021) - $203
After the deductible is met, Medicare picks up 80% of assignment or contracted payment. Medicare-approved doctors can charge up to 15% over assignment, which means Medicare isn't pay 80% anymore but only 73.5% and the consumer pays the rest, called co-insurance.
Part A-Hospital, hospice, skilled nursing facility and home health.
Part B-Out-patient, labs, medical equipment, limited medications, and mental health.
An individual on Medicare or a private health insurance is still covered by the terms of the plan. This means a few things. 1) Only money paid towards covered healthcare services and treatments will count towards the deductible. 2) The doctors and medical professionals need to be Medicare approved, or "take" the private insurance, and 3) the doctors will charge prices based on agreements with Medicare or the hypothetical insurance company.
Medicaid plans don't have deductibles. They are designed to be zero-cost to super-low cost for needy individuals. If someone isn't "needy enough," but their Medicaid starts to pay after they pay a certain amount for covered healthcare, that's called spend-down. This may sound like a deductible, but because folks with spend down aren't restricted to the terms of Medicaid, doctor networks, etc, it's not a deductible. This means the doctors will charge patients with spend-down more than they would normally get paid by Medicaid. If the person with spend down is also on Medicare or a private insurance, the doctors have to charge based on the terms of the primary plan. Usually, only state-approved treatments and spending counts towards the spend-down, but not always. Medicaid can get really tricky, so it's best to get confirmation of coverage from the doctor's office and Medicaid office.
On Medicare, the doctors must treat you if you haven't met your deductible. On private insurance, or with a Medicaid spend down, the doctors might (but not always) refuse to treat you until they receive payment.
There is a lot to cover with deductibles. In a future post I will talk about ways to eliminate the Part A and Part B deductibles. There are supplements, cost plans and MAs available that eliminate these for the consumers. Thank you for reading. Take care.
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