Most people picking health insurance focus on copays and deductibles and miss the out-of-pocket maximum, which caps your total spending. A $500,000 claim gets limited to $8,000 on a high-deductible plan. Hospitals offer interest-free payment plans, so a higher OOP max is manageable if you want lower monthly premiums.
How much do you think people overvalue or undervalue out-of-pocket max? It seems like a really critical decision factor with people that are enrolling in plans. So oftentimes in our environment, an employee is going to have multiple options, right? 2 to 3 different plans they can enroll into. And you know, you might see, so for example, I'm on the Silver III high deductible plan with my family, which means my out-of-pocket max is going to be higher. How much do you think people over or underestimate the importance of that?
I think because it is a kind of the worst case scenario, a lot of people are just worried about a copay or deductible amount and really aren't looking at this quite as much. And you know, this number, to put it in perspective, if we've got time at the end, I'm going to show you some claims where the prescription or an average claimant on the high side could be hundreds of thousands of dollars. So if I'm getting care, gonna, it's, you know, I've got half a million dollars in claims and I can cap out at $8,000. You know, I consider that a win. And I'm more of a risk taker where I don't think I'm going to get sick. So, I would rather have a little less coming out of my paycheck and go with a higher out-of-pocket maximum. And then if something catastrophic did happen, I know I've got a cap of this $8,000. But part of it is about educating the workforce and, you know, having some money set aside if you can. And then depending on your risk structure, if you're less risky, then maybe you do want to have more of this you know, the Gold One, where it's a $3,000 maximum. But I think one thing that people don't know or don't think about is when you do go in a hospital and you have catastrophic care, 99 times out of 100, the hospital is going to work with you on a payment plan to get it back, right? So when you get an $8,000 bill, the hospital is going to say, hey, we'll work with you to pay that $8,000 off over the next 24 months. Typically, it's interest-free. So there's a lot of different ways where if you do run into the situation of, of big claims, you can work with the entity to get a payment plan set up.
