The IRS Deductions Blog

Posts Tagged ‘health’

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Question: Is your healthy insurance premium tax deductible? Is it better to do a group plan or individual plans?

I have a small company with three employees – is it better we get a group health insurance plan or all get individual plans? what are the tax benefits? I was told you can deduct more of the premiums if you are a company rather than an individual?

Answer: I have been a tax accountant for 27 years. I do not have enough information to give you a reliable answer to your question. However, you should look into a relatively new tax development called the HRA or HSA. Your bank should be able to provide you with information as to how these plans work. They are very flexible and work only when people purchase high-Deductible Health plans. The HRA or HSA accounts are used to pay out-of-pocket medical expenses (but not the insurance premiums) such as your deductible or co-pays under the plan. They are like IRA accounts for your health. I like them a lot. Please don’t be a fool; consult a tax professional. You are in a very complicated area of tax law.

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Question: I need some help understanding health insurance “out of pocket” and “in network” and “out of network”?

This is a plan from Aetna. I’m an single male wanting to get on this plan. I don’t understand a few things. First “out of pocket” being $7,500 for individual, what exactly does out of pocket mean? If the deductible is 0.. I just don’t get it. And what is “in network” and “out of network”. Thanks!

*In Network*
deductible – $0 individual / $0 family
co-insurance – 30% (0% once out-of-pocket max is satisfied)
out-of-pocket maximum – $7,500 Individual / $15,000 Family
*Out of Network*
deductible – $5,000 individual / $10,000 family
co-insurance – 50% (0% once out-of-pocket max is satisfied)
out-of-pocket maximum – $12,500 Individual / $25,000 Family

Answer: What are hte cost os these plans? They look decent.

In Network – doctors in your area that have signed up to be part of Aetna’s network. You get a discount because they are “in network”
Out of Network – all the doctors in the United States who didn’t sign up to be in Aetna’s network.

Deductible – amount of money you must spend before your plan starts paying for medical care. In you go in network you don’t have a deductible (it pays the first dollar). If you go “out of network” you have to pay the first $5000.

Out of pocket maximum – If you go to an “in network” doctor your plan will pay on the very first doctyour plan will start paying at the first dollar you spend. But until you met the maximum out of pocket you will have to pay a portion (either 30-cent for each dollar or 50-cents for each dollar).
- What this means on the out of network is that you pay all of the first $5000; for the next $15000 you will pay 50% (= $12500 = $5000 + 15500/50%)

Hope this makes sense.
Also, networks vary by geographic area. Aetna has a very good network in my area. I think every doctor I have tried to go to (I haven’t tried to go to that many) has been a member of the network.
Aetna also has a really good website that you can find the doctors in your area.

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