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    What is the difference between deductible and payment limit (per calendar year) in regards to health insurance

    a few seconds ago 3 Answers

    Best Answer

    usually the deductible gets paid first - like the first $250 of med expenses each year then insurance covers 80% of the next $5000 - so insurance pays 4000 and you have to pay 1000 - that's probably the payment limit your referring to, then usually expenses over 5000 in a calendar year are 100% paid by the insur company, so your annual total out of pocket cost in this example is $1250. ask your benefits person at work for exact details
    a few seconds ago

    Other Answers

    • Stick with me this will make sense sooner or later. Basically a deductible is what you pay for before the insurance company will kick in with any coverage. If you have a $1000 limit per calendar year on some service, the insurance co. will indeed pay $1000 on that item. However, you have to pay your deductible, say $100, before they will pay their part. It varies with different policies on how this is done but with the majority of plans, plan that each year you will spend at least what your deductible is for health care, if you need to use your policy. If you have more questions about this ask again. It is best to talk to your human resources dept. or your insurance provider to understand the particulars on your policy. So you don't have any surprises you really need to understand your coverage. Coverage changes per service and it all can get quite complicated. Don't feel that there are any dumb questions here. Remember you can understand it, you need to understand it, so be sure you ask about your policy.

      by Jo - 4 hours ago

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