Navigating the Health Insurance Landscape by Robert Adziashvili - HTML preview

Navigating the Health Insurance Landscape

4. ACA: Deductibles/ out of pocket maximums: the role of copayments and coinsurance D educ t i bl es an d o ut -o f-po c k et maxi mums are i mpo rt an t t erms t o un derst an d when i t c o mes t o heal t h i n suran c e. A deduc t i bl e i s t he amo un t o f mo n ey yo u hav e t o pay o ut o f yo ur o wn po c k et befo re yo ur i n suran c e st art s t o c o v er t he c o st s. Fo r exampl e, i f yo u hav e a $5 0 0 deduc t i bl e an d yo u n eed t o see a do c t o r, yo u wo ul d n eed t o pay t he fi rst $5 0 0 o f t he bi l l , an d t hen yo ur i n suran c e wo ul d st art t o pay fo r t he remai n i n g c o st s. D educ t i bl es c an v ary depen di n g o n yo ur i n suran c e pl an , an d so me pl an s may hav e hi gher o r l o wer deduc t i bl es.

O ut -o f-po c k et maxi mums, o n t he o t her han d, are t he maxi mum amo un t yo u wi l l hav e t o pay fo r c o v ered medi c al expen ses i n a gi v en year. O n c e yo u reac h yo ur o ut -o f-po c k et maxi mum, yo ur i n suran c e wi l l c o v er 1 0 0 % o f t he c o st s fo r t he rest o f t he year. It 's i mpo rt an t t o n o t e t hat n o t al l expen ses c o un t t o wards t he o ut -o f-po c k et maxi mum. Fo r exampl e, premi ums ( t he amo un t yo u pay fo r yo ur i n suran c e eac h mo n t h) an d o ut -o f-n et wo rk c harges may n o t be i n c l uded i n t he o ut -o f-po c k et maxi mum.

Co paymen t s an d c o i n suran c e are t wo ways t hat yo u may be requi red t o share t he c o st o f medi c al serv i c es wi t h yo ur i n suran c e c o mpan y. A c o paymen t , o ft en referred t o as a " c o pay," i s a fi xed amo un t t hat yo u pay fo r c ert ai n serv i c es, suc h as a do c t o r's v i si t o r a presc ri pt i o n medi c at i o n . Fo r i n st an c e, yo ur i n suran c e pl an may requi re a $2 0 c o pay fo r eac h v i si t t o a pri mary c are physi c i an . Thi s mean s t hat