I’m 25 years old, part of a union, and work a government job, but I don’t really understand how health insurance works. I’m from Washington State and make about $50k a year. I mentioned the union because we all pay the same amount per paycheck, whether you’re single like me or supporting a family of four. I pay $98 per paycheck, or about $200 per month. Do I have good coverage? I have Regence Blue Cross Blue Shield with a $20 copay, a medical deductible of $300/$900, and a medical out-of-pocket maximum of $2,300/$6,900. How does it work? Why are there two numbers for the medical deductible (300/900), and what do they mean?
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The two numbers can mean two things. If you have a PPO, it likely means individual/family. This means your deductible is $300, and for a family, it’s a combined $900. The family part doesn’t apply if it’s just you with no dependents.
Or,
it could be in-network/out-of-network coverage. You might have a $300 deductible for in-network doctors and a $900 deductible for out-of-network doctors.
You should ask your HR department or whoever handles employee benefits for a summary to explain the basics of your plan coverage.
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ok thanks that makes sense thank you.
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I usually suggest that people unfamiliar with the American healthcare system watch “A Terrible Guide to the Terrible Terminology of US Health Insurance” by Brian David Gilbert on YouTube.
It provides a good amount of basic information. Hope that helps!
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I appreciate it and thanks for responding.
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It looks like a very good plan. I’m not sure why a family of four would pay the same as you, though. Hopefully, the plan covers the whole family and not just the employee.
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Your $20 copay and $200 monthly payment suggest you have good benefits. To understand what your insurance will cover, look at the deductible. For example, a $300 deductible means you pay that amount yourself before your plan starts covering costs, up to $900 total. Your yearly out-of-pocket limit for covered services is $6,900. After reaching that, your insurance covers everything. Understanding these terms helps you manage healthcare costs better. If you have specific questions, it’s a good idea to contact your insurance company for more details.
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Try uploading your statement of benefits into an AI chatbot and ask for an explanation. I’ve used Google’s notebooklm service for this, and it quit works really well.
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Have you asked your union? They should be able to explain it or give you materials that do. They should have already provided that information to you.