Does anybody understand how the out of pocket max works for our benefits? I reached my deductible forever ago, but now there is this out of pocket max and even after 11 months I’m nowhere close to reaching it. Which is odd because I’m constantly in and out of the hospital due to a lovely autoimmune disease I got.
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Llamanatee
Former Entertainment Specialist, Electronics/Tech
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When you hit your deductible they pay 80%. When you hit your out of pocket max, they pay 100%. I’m about 400$ from hitting my max. Almost sad it’s about to start over.
can't touch this
PhD
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I’m guessing the deductible is stupid high, like $5,000?
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One of the reasons you may not be close to hitting the max yet is due to using in network doctors/hospitals and the discount that provides. One example: my husband recently had some injections in his back for arthritis. The shot was $5000. Because we used an in network doctor for the procedure (and it was preapproved) we received a discount of $4600. Of the remaining $400, Target covered 80% ($320) and we paid $80. Only the $80 is applied to our maximum out of pocket expenses. They don't pay 80% until we have met our deductible (we have) and then it's the 80/20 after discounts are applied. I have nothing but praise for our insurance (we use HRA). And the total deductible for both of us is about $2200, of which we can earn $1000 in that in the healthy reward activities. It has been a wonderful benefit for us. Of course, about half of my pay goes towards the premiums, but when there is a major health problem (like the back surgery he had last year) it is worth it.
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garbage
Former TPS/Current Security at major grocery chain
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I hit my out of pocket every year right before it starts over. Really sucks.
Worse, just found out my medication is no longer covered under Target's insurance, and I won't be able to afford the around $500/month for it.
Pretty shitty that companies can just pick and choose which medications to cover, especially when there aren't alternatives.
Worse, just found out my medication is no longer covered under Target's insurance, and I won't be able to afford the around $500/month for it.
Pretty shitty that companies can just pick and choose which medications to cover, especially when there aren't alternatives.
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It varies plan to plan and likely state to state, but since it's just me on the HRA plan, it was like $3800/year out of pocket, NOT including anything I spent out of network or on medications.
If you have another person on the plan with you, the individual amount goes up to like $7k.
I pay about $5400/year out of pocket currently, including medications, and like I said one will become unaffordable in April.
The worst part is, a lot of this seems to be due to an injury I sustained on the job, but Target's work comp people got them out of paying for it.
My initial diagnostics for the issue cost me nearly $8k, and that's still in limbo because Target rejected it retroactively after pre-authorizing me for the tests, and my medical insurance won't cover it because the tests were run after and because of a work related injury.
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Healthcare pricing is ridiculously screwed up in our country.
A lot of it is simply doctors/clinics charging the absolute maximum because they know they're going to be forced into a "negotiated price" with the insurance company anyways, and they can't really keep track of all the different plans they deal with on all the different codes.
Same with medications; they justify the insane costs by saying the consumer doesn't pay, the insurance company does, but then the insurance company turns around and says "no name brands," "no specialty medications," "no medications over $1800 a month," and they neglect to mention that most people with HSA plans pay the full amount of prescriptions up until their deductible or out of pocket maximum.
And have you noticed that that stupid "Rally" website that Target partners with has our medical information? I was really upset to see that a list of my conditions and medications was on a 3rd party website like that, and I didn't know I agreed to have that sensitive information passed on.
It's made me very concerned that Target knows more about my medical issues than they reasonably should, and I'm very afraid they might be motivated to move me out based on my healthcare costs.
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Stay off rally.
Amanda Cantwell
Service Advocate
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doesn't rally let you complete healthy activities to lower your deductible? I wouldn't say it's all bad.
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Only reason I ever went there was it was required for the $500 reward, and that's not insubstantial with my medical expenses. Was really, really unhappy to see it's basically an info stealing scam and possible HIPAA violation.
And this year, the better part of the "reward" ($300 for me) is only given for going in to a doctor's appointment that will cost 2-3x the price of the reward...
And this year, the better part of the "reward" ($300 for me) is only given for going in to a doctor's appointment that will cost 2-3x the price of the reward...
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