What is the deductible for chronic diseases?

There is no nationally unified fixed value for chronic disease deductibles. At present, the annual deductibles for chronic diseases in employee medical insurance in various places are mostly in the range of 100-500 yuan. The deductibles for residents’ medical insurance are even lower, generally between 0 and 300 yuan. Many places have also set up zero deductible policies for common chronic diseases with high incidence such as hypertension and diabetes. To put it bluntly, the deductible is the threshold for medical insurance reimbursement. Your chronic disease compliance expenses within a year must first cover this amount yourself, and the excess will be reimbursed by medical insurance on a pro-rata basis.

Many people may wonder why there are so many differences between places? In fact, this is essentially directly linked to the affordability of local medical insurance pooling funds. After all, the number of insured persons, the proportion of chronic disease patients, and the fund balance are different in each place, so the thresholds set are naturally higher and lower. A while ago, I helped a friend from Jinan, Shandong, calculate the reimbursement accounts. She is covered by employee medical insurance and registered for outpatient chronic disease of rheumatoid arthritis. The local annual minimum payment for this kind of common chronic disease is 400 yuan. She prescribes medicine for the first time this year. For the compliant drug fee of 420 yuan, I paid the minimum payment of 400 yuan, and the remaining 20 yuan was reported at a 70% ratio. As long as the medicines prescribed later are within this year, there is no need to pay the 400 yuan again, and the proportion is directly quoted. If she is applying for the "two disease" registration of hypertension and diabetes, there is no deductible in the local area. She can directly reimburse the prorated amount for the first prescription, which can save a lot of money.

Of course, not all places can liberalize the zero minimum payment. I have talked with a medical insurance agent in a county in Shanxi before. The overall pool of their overall fund is small. After they tried to relax the zero minimum payment for two diseases in the past two years, many people began to pretend to prescribe antihypertensive drugs and resell them. Later, the minimum payment line for residents' chronic diseases was adjusted back to 100 yuan per year. At the same time, they stepped up efforts to investigate insurance fraud, for fear of abusing the medical insurance fund, and in the end, seriously ill patients who really need reimbursement will not be able to reimburse. Now there are voices from both sides. Patients with chronic diseases definitely want the lower the deductible, the better. After all, taking medicine all year round is a big expense. The medical insurance department also has to keep an eye on the safety of the fund pool and take into account the rights and interests of everyone. Therefore, in the past two years, most regions have been gradually lowering the deductible, rather than canceling it all in one step.

There is another small detail that many people don’t know. In many places, for major chronic diseases such as malignant tumors, radiotherapy, chemotherapy, and uremia dialysis, the deductible is connected to the hospitalization deductible. If you have already paid the hospitalization deductible for hospitalization, you will not have to pay the threshold fee again for treatment of chronic diseases, which can save a lot of money. If you want to know the specific standards in your local area, it is most accurate to directly call the 12393 medical insurance hotline to ask, or check the official announcement of the local medical insurance bureau, which is much more reliable than searching the old information from a few years ago on the Internet.