Recent comments in /f/explainlikeimfive
AdmiralAkbar1 t1_iy2p2xo wrote
Reply to ELI5: Health insurance basics. What are copay and deductibles and can you use them in some basic examples? by OvernightSiren
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Premium: The monthly fee you pay to the insurance company.
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Deductible: The amount you have to pay for a good or service before your insurance kicks in and covers the rest of your cost.
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Copayment: Also abbreviated as copay, this is the flat rate you pay for a good or service that's covered by your insurance.
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Coinsurance: This is when you still have to pay some of the costs above the deductible, usually a percentage value.
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Out-of-pocket maximum: If your combined payment for deductibles, copay, and coinsurance goes above this amount within a year, everything above that is paid by your insurance company.
Let's go with an example to illustrate how these all interact. You have an insurance plan with a $2,000 deductible, 20% coinsurance, $100 copay for a doctor's visit, and an out-of-pocket maximum for $4000. You get into an accident that requires surgery; the hospital bills your insurance company for $10,000. This means you've gotta pay $2,000 to cover your deductible. Of the remaining $8,000, also you have to pay 20%, or $1,600, as coinsurance. You have five followup appointments with the doctor to see how you're recovering. You pay your $100 copay for the first four appointments, but the fifth appointment doesn't require a copay, because it's above your out-of-pocket maximum.
Now, there are plans out there that have lower deductibles, copays, coinsurance, and/or out-of-pocket maximums, but those usually have the tradeoff of charging a higher monthly premium. Some insurers also have special deals with medical providers where they get better rates; you get full benefits if you use those providers ("in-network"), but you only get partial or no benefits if you use others outside the network.
Most insurance is provided by one's company, usually with a discounted premium. The US government also has several insurance programs: Medicare for the elderly, Medicaid for those below the poverty line, VA benefits for veterans.
spddemonvr4 t1_iy2oqa6 wrote
Reply to ELI5: how are chinese protesters able to post videos with the great chinese firewall controlling internet? by TImetalker
In short VPN or just PN.
While the Chinese government shuts down most access to known Vpns, it's nearly impossible to block all IPs available. I can set up a email sever that isn't blocked then tell some one in china to save content to it. It will run until their IT teams find and block it... Then rinse and repeat after the server is registered elsewhere.
Or worst case scenario, like they do in Cuba and N. Korea, store content on memory cards and bring them to another country to then upload to the web.
Wallaby99 t1_iy2olxt wrote
Reply to ELI5: Health insurance basics. What are copay and deductibles and can you use them in some basic examples? by OvernightSiren
Yeah, it's all confusing. The easiest way to think about it is there are limits that apply to your *total spend* per year, and there are limits that apply to your *per visit* spend.
Deductible and out-of-pocket max apply to your total spend per year.
Co-pay and Co-insurance apply to your per visit (and by visit, I mean any individual service, such as doctor visit, hospital stay, surgery, pharmacy medication fills, etc).
Let's start with the total spend terms.
Deductible: This is the amount of total spend you need before the insurance company kicks in a single dollar. So, for example, if you have a $1000 deductible, then you will have to cover the first $1000 of your total spend, before the insurance company starts covering anything.
Out-of-pocket max: This is the amount of total spend you need before the insurance company starts covering 100% of your costs. So, for example, if you have a max out-of-pocket of $5000, then after your total spend for the year hits $5000, everything after that will be covered by insurance.
So what happens between those 2 numbers, $1000-$5000? That's where the per-visit charges apply.
Co-pay: a *set* amount you pay for the visit. So for example, a doctor's visit may have a copay of $50. A hospital visit may have a copay of $500. And a medication may have a copay of $5. That means that regardless of the actual cost of those things, you will pay the copay. Let's say one hospital visit costs $1000, and one hospital visit costs $5000. Doesn't matter. Either way, you pay the $500 copay and the insurance company picks up the rest.
Co-insurance: a *percentage* amount you pay for the visit. Let's say you have a co-insurance of 20% for hospital visits. In this scenario, if a hospital bill was for $1000, then you would pay $200 (20%), and if it was $5000 then you would pay $1000 (again, 20%).
So basically, on January 1st, all the numbers rest. From there, let's say you have a few doctors visits and a couple of medications. Since you haven't "met the deductible" yet, you will pay 100% of the cost of those services, until you've spent $1000.
Then, once you've paid $1000 out of your pocket, the copays and co-insurance start applying. So at that point, any further doctor visits, you would pay the copay/co-insurance. Any hospital stays, medications, etc., same thing. You would be responsible only for the copay/co-insurance -- after you've met the deductible.
All these copays and co-insurances start adding up, and at some point, you will have paid $5000 out of pocket. At that point, the out-of-pocket max threshold is hit, and from then on, insurance will cover 100% of your expenses.
Does that make sense?
Finally, regarding in-network and out-of-network. Most insurance plans have negotiated discounts / preferred prices with specific doctors and hospitals. These will be considered in-network (they are part of the insurance company's network of "preferred providers" because they have set, negotiated rates with the insurance company). Doctors and hospitals that don't have a contract with the insurance company are technically allowed to charge you whatever they like, since they haven't negotiated any set pricing with your insurance company. These are considered out-of-network providers.
Insurance companies will have different deductibles, copays, co-insurance, max out-of-pocket, etc. for in-network vs out-of-network providers. Generally speaking, the numbers will be set lower (i.e. lower cost to you) for in-network providers, mainly as a way to incentivize you to see in-network providers, since they're generally cheaper for the insurance company (since they've negotiated their rates and signed a contract). Some insurance plans, such as HMOs will have *zero* coverage for out-of-network providers, to basically force you to stay in-network, in exchange for a lower premium or lower out-of-pocket costs. And others (Generally more expensive) will have better coverage for out-of-network providers.
Different insurance companies will have different doctors/hospitals in their network, based on who they've negotiated with. So for example, Insurance A might have doctor B and hospital C in their network, while Insurance D might have doctor E and hospital F in-network, while Insurance C might have all of them in-network.
My recommendation on how to shop for insurance is to first determine what services you will need. If you already have doctors that you see and you want to keep seeing them, make sure that they are in-network. That will generally give you the lowest out-of-pocket costs to see them. And don't forget the unexpected stuff. You may not need regular hospital care, but maybe you really want to make sure the local University hospital is covered in case you ever need specialized care. If an insurance company's only in-network hospital is 50 miles away from you (not uncommon if you don't live in a big city) while the hospital 5 minutes away from you is out-of-network, make sure you know that before signing up.
Next, determine how important out-of-network coverage is for you. If you want the freedom to be able to go to anyone you want, or any hospital you want, then you'll want to pay extra to get good out-of-network coverage.
Finally, look at the cost of the various plans, and, once you have all of the above info about the different plans, hopefully you'll be able to choose one that contains the right balance of in-network and out-of-network costs, with the best set of in-network providers (based on who you want to get care from), for the best price. That's a difficult juggling act, but if you first gather all of the information, you'll have a better shot at making the right decision.
Good luck!
PS insurance companies make it somewhat difficult to find out who is in-network and who is out-of-network. One common tactic is to say "Oh, we at Blue Cross contract with a thousand physicians!" That may be true, but each insurance company sells dozens of different insurance plans. And the network for each plan is *not* the same. So you have to make sure you check the network not for the company as a whole, but for the specific plan you're checking out.
[deleted] t1_iy2ohfk wrote
[deleted] t1_iy2of6l wrote
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[deleted] t1_iy2oad1 wrote
cx5zone t1_iy2o91e wrote
Reply to ELI5: how are chinese protesters able to post videos with the great chinese firewall controlling internet? by TImetalker
Well, the exact way is secret of course. And shouldn't be digged at too hard lest the Chinese government just stumble on a reddit post explaining it and then fixing it. But basically, no wall is perfect, there's always holes if you look hard enough. Even the Iron curtain and Berlin wall let some people through. But the great Chinese firewall do nothing about passing along physically. For example, as soon as a thumbdrive reaches a computer not governed by that firewall, uploading is simple. There are also ways to bypass firewalls, every lock is beatable, it's just a question of time
imnotsoho t1_iy2o7gr wrote
Reply to comment by TheLuteceSibling in Eli5: Why did ships and navies come up with their own system of units (nautical miles, knots, fathoms, etc)? Is it still used? by Dewi2020
That is also why we all pretty much use Arabic Numerals. Ever tried to do math with Roman Numerals?
bradles0 t1_iy2nwt8 wrote
Reply to comment by K3piper in eli5: Different body hairs grows differently by kenito225
>and to re-grow when cut back.
it doesn't actually do that, you are just experiencing hair life-cycle.
hair grows out to x length, and then stays that long for however long (head hair is ~2 years, body hair can be as short as two weeks), then the follicle "dies", the hair falls off the follicle, and then the follicle regrows itself and does it all again. If you cut a hair in half it will be half as long for the rest of the life cycle - this is why regrowing cut head hair takes 2+ years to get to full length (although head hair is a bit special because it doesn't have a cap length), but e.g. chest or leg hair can recover in a month or two, and will APPEAR to recover even faster, because half your hair was at the end of the its cycle when it got shaved.
pcherna t1_iy2mza8 wrote
Reply to ELI5: Health insurance basics. What are copay and deductibles and can you use them in some basic examples? by OvernightSiren
Copay is your cost for each visit. Depends on the service. It might be $20 to see your doctor. $40 for a specialist. $300 if you’re admitted to the hospital.
Deductible is the amount you have to pay before insurance kicks in. Say yours is $1500. In some plans that’s for medical services beyond visits. So seeing the doctor my cost you $20 as a copay and insurance pays the rest. Now you need an X-ray which is $300. You have to pay that and that counts as part of your deductible. Now they send you for an MRI that’s $4000. The first $1200 is on you (the rest of your deductible), then the insurance covers the rest.
Lots of fine print. Some plans pay everything past the deductible. Some pay 80% of that and you still pay 20%.
In some plans the deductible only applies for stuff like X-rays, MRIs, and surgeries. Other plans it may apply to other basic visits.
Your health insurance has doctors and clinics that they have a contract with that covers rates. These are in network and normally a lot cheaper for you. If you go to a different doctor not on their list, it’s considered out of network which means at least two worse things. One is lower coverage, and the other is insurance only covers at their “normal” rate. Say you see an allergist, and their bill is $200. Insurance says “we cover 80% of our standard rate. Our standard rate is $150 so we may $120” So you end up owing 80 to the allergist.
If you have a genuine emergency while traveling (eg chest pain) on a decent plan you can get emergency service even at an out of network hospital but you may have to call first.
Letthembeefcake t1_iy2mmh2 wrote
Reply to Eli5: Old Three Stooges episodes show people occasionally breathing into paper bags as some sort of remedy for emergency situations involving stress or trauma… what was the belief then and what do we now know better about the practice? by coffeygrande
Perhaps not the main intent, but filling up the bag on the exhale and draining it all the way on the inhale helped people to focus on deep breaths instead of shallow, quick breaths.
VulcanVisions t1_iy2m62l wrote
Reply to comment by Kay1636 in ELI5: How does buffalos get so big while being herbivores? by Kay1636
No problem, my first degree was in Biology and this is precisely how we were taught it.
[deleted] t1_iy2lz86 wrote
Ricwil12 t1_iy2lt8o wrote
Reply to comment by gubasx in ELI5: how are chinese protesters able to post videos with the great chinese firewall controlling internet? by TImetalker
Or the great Chinese censorship is a Western creation.
Kobold_Archmage t1_iy2lfke wrote
Reply to eli5. There is no air in space as per science and air is needed to have a fire. What’s the reason the sun keeps burning? by Zaiik
You literally claim to have a doctorate degree and don’t understand this? How?….
gubasx t1_iy2kofc wrote
Reply to ELI5: how are chinese protesters able to post videos with the great chinese firewall controlling internet? by TImetalker
Well.. even if we knew.. it would be really dumb to explain it here publicly so that the Chinese censorship machine would also be able to see it and use that info to stop it.
[deleted] t1_iy2kkvo wrote
HermitDash t1_iy2k67v wrote
Reply to ELI5: Health insurance basics. What are copay and deductibles and can you use them in some basic examples? by OvernightSiren
Deductible is what you need to pay out of pocket on your own before the insurance plan starts covering you for future visits. You can either pay out of pocket and have the office bill your insurance towards that deductible or you can pay it out right through your insurance. Once your deductible is satisfied your insurance will start covering services either in full or at a cost to you that isn't full price. Considering there's a bunch of different plans your "copay" (the cost which your insurance charges you now that you've satisfied the deductible) applies and you just pay that small amount for the visit of what ever medical service you go to.
Now to go into what your plan premiums are, in layman terms that's your monthly fee to keep your plan active, while also having a deductible to pay so you can access medical services you need
WeDriftEternal t1_iy2k338 wrote
Reply to comment by 7th_Level_of_Hell in Eli5: How do companies predict if gas will go up tomorrow? by robric18
Yup. That’s why I said it’s directional, not proportional
SoulWager t1_iy2jz3f wrote
Reply to comment by ScienceIsSexy420 in ELI5: how does fresh water ice forms out of sea water( salty), shouldn't it make salty ice? Does water "purifys" itself during phase conversation or what? by UniqueCold3812
And when sea ice is forming, underneath the ice layer it forms a brinicle of highly salty and colder water.
7th_Level_of_Hell t1_iy2jxt9 wrote
Reply to comment by WeDriftEternal in Eli5: How do companies predict if gas will go up tomorrow? by robric18
>. If oil goes up, gas goes up, if oil goes down gas goes.
Gas goes down at a slower rate* ;)
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[deleted] t1_iy2jec7 wrote
geek_fire t1_iy2isnx wrote
Reply to comment by shellshocktm in Eli5 - What is the real meaning of being queer? by confusedsoul95
I guess I've never seen 'queer' as an ideology, so much as a descriptor of personal characteristics and identity.
MrUnlucky-0N3 t1_iy2pa1y wrote
Reply to eli5 Why is it not excepted to only have one pair of clothes by No-Struggle5102
Having only one set of clothes is inconvenient. Your set of clothes wil not be suited well for all times of the year, you might be hot in the summer but cold in winter too.
As someone pointed out, you'd have nothing to wear while your set of clothes is in the laundry, which, would be quite often if you don't want your clothes to smell.
Different kinds of clothing need cleaning on different cycles. It is common to change underwear every day, t-shirts at least after two days and jeans can sometimes be worn for a week without smelling.
The wear on your clothes is not spread out. Your clothes will break more quickly if you wear and wash them a lot. Especially clothes like jeans can lose a tiny bit of color with every wash and look quite bad after many wash cycles.
If you only had one set of clothes, a laundromat would be wasted, because they usually can't use little enough water for that few clothes, so you would likely need to hand wash.
Socially:
People will notice you wearing the same clothes every day and draw conclusions. Most will, irrespective of your actual laundry habits, assume you walk around in dirty clothes half the time.
In case you are talking about one "selection" of clothes and multiple duplicates of each, that is usually considered weird, but still somewhat fine. If that's what you are after, I'd advise you to buy two different styles of pants and shirts so you can look somewhat unique between your outfits and still keep the simplicity.