so my company i work for just got insurance. i’m 20, living in tn with little to no life experience. im learning as i go and i’m pretty intelligent and good at figuring stuff out but insurance? lord have mercy i can’t figure it out. anyways, here’s all i know.
it’s a package plan ig? i get dental, vision, and health. it’s copay too. i used to make 500$ a week now i make 400 something. ik they take out 78-80$ a week for the insurance and my company takes out 40 something. idk the intricate details of it i’m sorry lol. anyways, i desperately need medical attention. i haven’t been to the dr in years, same with the dentist.
from my health insurance i have zero to no idea abt it. but my dental ik i have a general maximum [incentive] of 2500 and a orthodontic maximum of 1500. idk what any of that means but from what i’ve gathered is i have to pay out of pocket after each medical visit until i reach said maximum. after that the insurance will cover half? idk for sure though… it’s so confusing 😭
it’s delta dental if anyone’s wondering.
my main concern is will i still be able to see a dentist/dr? and upon going in will they demand payment upfront (i’m hella broke so i’m hoping this isn’t it). will it be some payment plan type of thing? is the 70-80$ out of my check actually going towards anything bc online, at least on the delta dental site it shows i haven’t paid anything on it butttt that money is being taken out my check?
idk it’s all so confusing and just need someone who has life experience to help me out 😭 we all learn somewhere so don’t judge me please.
Posted by grippasniffa
2 Comments
I’m procrastinating on cleaning my basement, so let me try to cover as much as I can.
Health insurance is broken down to a few main components:
* Deductible: The amount you pay before insurance pays on the majority of your services
* Copayment: If applicable, a **flat rate** amount that you pay to the doctor’s office while insurance typically pays the remainder. It’s normal to have a lower copayment for primary care vs specialists
* Coinsurance: A percentage that your insurance pays once you meet your deductible with you paying the remainder (80%/20% for example)
* Maximum Out of Pocket: the combination of deductible, copayments, and coinsurance that you must meet before your insurance pays for allowed services at 100%, assumptions that you’re in network as well
[This is also a great video to recap health insurance.](https://www.youtube.com/watch?v=xs7MNNqdN-o)
Always check with your insurance before you go see a doctor to make sure they are in network/participating. This allows you to get the best benefit for your plan.
>and upon going in will they demand payment upfront
If you have a copayment on your plan, they can ask for payment, and it’s up to you to tell them if you can’t afford the copay right away. Perhaps they can work on a payment plan with you.
>is the 70-80$ out of my check actually going towards anything
No, it essentially is collected by your employer to help pay the insurance company for covering you. Premium has nothing else to do with insurance, and your insurance will never directly bill you for anything.
The money coming out of your check is paying for the premium, or the fee, to have that insurance.
The maximums for dental insurance are usually the maximum the dental plan will pay. If you post a screenshot of your coverage chart, we could probably help explain more, just redact any personal information.
Usually dental plans will cover an exam at no cost to you. Depending on the plan, they might cover X-rays in full and one or two cleanings a year in full. These are typically considered preventative services.
Orthodontic coverage refers to braces and anything involving straightening teeth or fixing your bite.
Dental coverage would be X-rays, cleaning, fillings, pulled teeth, crowns, etc.
Your health insurance would be for seeing a doctor for anything other than eyes or teeth. If your health plan is ACA compliant, you’ll have a physical covered in full every year, and age appropriate preventative services covered at no charge. This could be an annual women’s well visit at an OBGYN, Pap smears are also covered every 3 years, cancer screenings, etc. health insurance would also have to cover birth control at no cost to you based on ACA guidelines – they’d have to cover one method out of the FDA approved methods at no cost. Some plans cover all options, some employers don’t have to provide this benefit for religious reasons or other exemption.
A lot of the stuff you’re due for will probably be covered at no cost to you. What you need to do is:
– look at your dental coverage and determine what the cost is for preventative services
– do the same for your health insurance
– use the tools on the website for your dental and health plans to find covered providers near you
– reach out to these doctors, see if they’re accepting new patients and make an appointment. When you’re searching for providers online you can usually sort by who is taking new appointments. When you make the appointment, they’ll need the info from your card. Confirm with them that they do accept your insurance.
Typically, you’ll have to pay any copay or charges not covered at the time of your appointment, you can always ask for an estimate of the charges and ask when payment is due!