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How to figure out Out of Pocket with 2 Insurances?

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  • How to figure out Out of Pocket with 2 Insurances?


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Answer #1 | 19/12 2013 09:27
First, you will have to pay the primary deductible so already you are responsible for paying 1,000 out of pocket. Then you apply the 80% coverage on 15,000-1,000=14,000. So, 14,000*80%=11,200. 11,200 is how much the primary insurance covers after your deductible (you are not responsible for this amount), thus you are then left to pay 2,800 (the 20% not covered by the primary coverage). In total right now you will pay the 1,000, primary deductible, and the remaining 2,800. Next, your secondary coverage kicks in and you must pay the secondary deductible of 500 out of pocket. Then you apply the 85% coverage on 2,800-500=2,300. So, 2,300*85%=1,955. 1,955 is how much the secondary insurance covers after your deductible (you are not responsible for this amount), thus you are then left to pay 345 (the 15% not covered by the secondary coverage), and since this amount does not exceed the out of pocket minimum then no more coverage is provided. So, your grand out of pocket total will be: 1,000+2,800+500+345=$4,645. Not bad for a $15,000 bill! Hope this helps!
Positive: 19 %
Answer #2 | 19/12 2013 18:43
The easiest way to figure it out, is with cardboard cutout overlays. Primary will pay 80% of $14,000, or $11,200. So, let's pretend primary doesn't exist. Secondary would pay $13,500 (max out of pocket). To find out what secondary REALLY pays, you subtract what the primary paid, from what secondary WOULD have paid, and then you find out that secondary pays $2300. You would still end up paying $1500. Above is incorrect. You don't pay both deductibles. The only difference I'd point out, is that the service repricing is done ONLY by the primary - and the secondary uses those adjusted numbers.
Positive: 13 %

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