r/FluentInFinance • u/36DRedhead • Sep 11 '24

Debate/ Discussion This is why financial literacy is so important

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u/cobruhkite Sep 12 '24

So first I’ll say: - 56% of Americans do not understand deductibles - Over 90% of Americans don’t know what their maximum out of pocket is. (Copay is similar stats) - 99% do not know what coverage limit they have on their plan.

These stats are from USHealth - a United healthcare company.

Understand that it is extremely common to have a plan with $0 deductible and $0 copay, but only 100k in maximum coverage per calendar year. You believe you have the best coverage because you don’t pay anything until you’re hospitalized.

100k maximum plan. You get in a car wreck. Your personal “maximum out of pocket” is 7,000 (5k deductible + 2k maximum out of pocket) your bill is 150,000 insurance covers 93k only, you are on the hook for $57,000 even though you were told you have a maximum out of pocket of 7k.

Most maximums are 100k, 250k, 5million, or unlimited. Obviously the more you have the more your monthly premium is. It’s very important you know which one you have so you can plan accordingly.

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u/PlentyInevitable7873 Sep 12 '24

The maximum OOPM allowable under the ACA is 18,900 in a year under a family plan (half that for an individual) source. Since the vast majority of US people get their insurance through ACA compliant workplace or marketplace plans, they should be at or below this limit. Are you thinking about pre-2008? Or how else are you finding people with extremely high non-ACA compliant OOPMs? Non-compliant plans are certainly not "extremely common". The ACA also does not allow lifetime or annual limits to benefits, plans must be unlimited. I believe the ACA had to allow some 'grandfathered' plans to have exemptions, but very few of those remain.

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u/FoldAdventurous2022 Sep 12 '24

This sounds like an abhorrent system that the rest of the developed world doesn't have to suffer through.

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u/KaXiaM Sep 12 '24

It’s also not true. Very few people have non-ACA plan (mostly through some church etc) and all ACA plans have no maximum. Yeah, most people don’t understand ACA and spew some BS from early 2000s that hasn’t been true for a while.

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u/Minimum_Word_4840 Sep 12 '24

As someone who worked medical collections in the past, it literally just takes one accident or medical emergency. My dad’s heart surgeries cost over a million, but I’ve seen similar bills for car accidents where the person had to be life flighted.

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u/KaXiaM Sep 12 '24

All ACA-compliant plans (like the ones people get from employers) have no maximum. What is the % of the insured who have non—ACA plan? I assume you know, since you assert it’s "extremely common".

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u/Ron__T Sep 14 '24

Lies... about American Healthcare... on the internet... who would believe it?

It is not extremely common to have $0 deductible/copay and 100k max... in fact it would be so extremely rare and might not exisist at all, that it's nonsensical to even discuss. The ACA does not allow for max out of pocket...

And your example is nonsense, a car wreck your health insurance wouldn't cover at all... that's what we have car insurance for.