Lets talk about copays, deducts and OOP yearly max .

Penelope

Diamond Member
Jul 15, 2014
60,260
15,765
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First off I'd like to say trump does not want health insurance for all, but access to health insurance for all, with lower deductibles. I firmly believe Trump knows nothing about Health insurance.

Copays the amount you pay when you visit a doctor , usually 25 for family and 50 for specialists
Deductible= when you meet the deductible then your plans pays 80/20 or even 70/30 or less depending on plan, this is called you coinsurance.
OOP is the important number, how much do you want to have to pay out of pocket before ins pays all.

Prior to the ACA, copays and medications were not covered in OOP max. Now if you have a condition, the major expense if follow up and twice a year visits to a specialist and perhaps many specialist.

Is this tiny nugget going to go away too??? and how it will affect you.

Read the below article:


Copay-based health plans prior to reform

Prior to healthcare reform, copays at the doctor or pharmacist did not count toward your deductible or out-of-pocket maximum. This wasn’t a huge deal for someone with low healthcare expense because a $35 copay here or a $10 copay there didn’t represent a lot of healthcare dollars.

However, this rule was a big deal for someone who was on multiple prescriptions and/or had numerous visits to the doctor. Why? Because this person was continually paying copays that didn’t ever get him or her any closer to meeting his or her deductible or out-of-pocket maximum.

Let’s take an example . Jake has a copay-based health plan with 80 percent coinsurance, a $2,000 deductible, and a $3,000 out-of-pocket maximum. After two doctor and three specialist visits, Jake is diagnosed with diabetes and told he needs to take two medications each month. Since Jake is on a copay-based health plan, he pays $25 for each visit to the doctor, and $40 for each specialist visit. The two medications will cost him $30 and $60 per month.

Therefore, Jake’s copays look like the following:

$50(2 doctor visits) + $120(3 specialist visits) + $360($30/month medication) + $720($60/month medication) = $1,250

This $1,250 does not count towards Jake’s deductible or out-of-pocket maximum. Why does this matter? Well, let’s say Jake gets in a car accident and has to be rushed to the emergency room for surgery. The medical bills from the emergency room total $17,000.

Jake is responsible for paying his deductible ($2,000) plus 20 percent of $17,000= $5,400

Jake’s out-of-pocket maximum is $3,000, so he’s responsible for paying $3,000 of the $5,400.

And this is all in addition to the cost of his copays, $1,250.

So Jake’s total medical bills for the year would be $1,250 (copays) + $3,000 (emergency room bills) = $4,250

Prior to reform, many people didn’t realize that copays were just empty payments that didn't count toward either the deductible or out-of-pocket maximum.

Healthcare reform has changed this, and now copays must count toward the out-of-pocket maximum. Let’s look at the rules post-reform.

- See more at: Do copays count toward the out-of-pocket maximum? The deductible?
 
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Jake is in a car accident, car insurance pays.
First off I'd like to say trump does not want health insurance for all, but access to health insurance for all, with lower deductibles. I firmly believe Trump knows nothing about Health insurance.

Copays the amount you pay when you visit a doctor , usually 25 for family and 50 for specialists
Deductible= when you meet the deductible then your plans pays 80/20 or even 70/30 or less depending on plan, this is called you coinsurance.
OOP is the important number, how much do you want to have to pay out of pocket before ins pays all.

Prior to the ACA, copays and medications were not covered in OOP max. Now if you have a condition, the major expense if follow up and twice a year visits to a specialist and perhaps many specialist.

Is this tiny nugget going to go away too??? and how it will affect you.

Read the below article:


Copay-based health plans prior to reform

Prior to healthcare reform, copays at the doctor or pharmacist did not count toward your deductible or out-of-pocket maximum. This wasn’t a huge deal for someone with low healthcare expense because a $35 copay here or a $10 copay there didn’t represent a lot of healthcare dollars.

However, this rule was a big deal for someone who was on multiple prescriptions and/or had numerous visits to the doctor. Why? Because this person was continually paying copays that didn’t ever get him or her any closer to meeting his or her deductible or out-of-pocket maximum.

Let’s take an example . Jake has a copay-based health plan with 80 percent coinsurance, a $2,000 deductible, and a $3,000 out-of-pocket maximum. After two doctor and three specialist visits, Jake is diagnosed with diabetes and told he needs to take two medications each month. Since Jake is on a copay-based health plan, he pays $25 for each visit to the doctor, and $40 for each specialist visit. The two medications will cost him $30 and $60 per month.

Therefore, Jake’s copays look like the following:

$50(2 doctor visits) + $120(3 specialist visits) + $360($30/month medication) + $720($60/month medication) = $1,250

This $1,250 does not count towards Jake’s deductible or out-of-pocket maximum. Why does this matter? Well, let’s say Jake gets in a car accident and has to be rushed to the emergency room for surgery. The medical bills from the emergency room total $17,000.

Jake is responsible for paying his deductible ($2,000) plus 20 percent of $17,000= $5,400

Jake’s out-of-pocket maximum is $3,000, so he’s responsible for paying $3,000 of the $5,400.

And this is all in addition to the cost of his copays, $1,250.

So Jake’s total medical bills for the year would be $1,250 (copays) + $3,000 (emergency room bills) = $4,250

Prior to reform, many people didn’t realize that copays were just empty payments that didn't count toward either the deductible or out-of-pocket maximum.

Healthcare reform has changed this, and now copays must count toward the out-of-pocket maximum. Let’s look at the rules post-reform.

- See more at: Do copays count toward the out-of-pocket maximum? The deductible?
 
Jake is in a car accident, car insurance pays.
First off I'd like to say trump does not want health insurance for all, but access to health insurance for all, with lower deductibles. I firmly believe Trump knows nothing about Health insurance.

Copays the amount you pay when you visit a doctor , usually 25 for family and 50 for specialists
Deductible= when you meet the deductible then your plans pays 80/20 or even 70/30 or less depending on plan, this is called you coinsurance.
OOP is the important number, how much do you want to have to pay out of pocket before ins pays all.

Prior to the ACA, copays and medications were not covered in OOP max. Now if you have a condition, the major expense if follow up and twice a year visits to a specialist and perhaps many specialist.

Is this tiny nugget going to go away too??? and how it will affect you.

Read the below article:


Copay-based health plans prior to reform

Prior to healthcare reform, copays at the doctor or pharmacist did not count toward your deductible or out-of-pocket maximum. This wasn’t a huge deal for someone with low healthcare expense because a $35 copay here or a $10 copay there didn’t represent a lot of healthcare dollars.

However, this rule was a big deal for someone who was on multiple prescriptions and/or had numerous visits to the doctor. Why? Because this person was continually paying copays that didn’t ever get him or her any closer to meeting his or her deductible or out-of-pocket maximum.

Let’s take an example . Jake has a copay-based health plan with 80 percent coinsurance, a $2,000 deductible, and a $3,000 out-of-pocket maximum. After two doctor and three specialist visits, Jake is diagnosed with diabetes and told he needs to take two medications each month. Since Jake is on a copay-based health plan, he pays $25 for each visit to the doctor, and $40 for each specialist visit. The two medications will cost him $30 and $60 per month.

Therefore, Jake’s copays look like the following:

$50(2 doctor visits) + $120(3 specialist visits) + $360($30/month medication) + $720($60/month medication) = $1,250

This $1,250 does not count towards Jake’s deductible or out-of-pocket maximum. Why does this matter? Well, let’s say Jake gets in a car accident and has to be rushed to the emergency room for surgery. The medical bills from the emergency room total $17,000.

Jake is responsible for paying his deductible ($2,000) plus 20 percent of $17,000= $5,400

Jake’s out-of-pocket maximum is $3,000, so he’s responsible for paying $3,000 of the $5,400.

And this is all in addition to the cost of his copays, $1,250.

So Jake’s total medical bills for the year would be $1,250 (copays) + $3,000 (emergency room bills) = $4,250

Prior to reform, many people didn’t realize that copays were just empty payments that didn't count toward either the deductible or out-of-pocket maximum.

Healthcare reform has changed this, and now copays must count toward the out-of-pocket maximum. Let’s look at the rules post-reform.

- See more at: Do copays count toward the out-of-pocket maximum? The deductible?

Jake was not in an auto accident, but dx with diabetes. Now auto ins and workers comp can be discussed elsewhere, but its not a given that in all states auto ins. covers all the medical bills.
 
Trump is in good company. Obama, Reid and Pelosi leading the Dems who passed the ACA said it had to be passed to find out what was in it. They didn't even know or understand what the lobbyists, insurance companies and big pharma had written for them.
 
Trump is in good company. Obama, Reid and Pelosi leading the Dems who passed the ACA said it had to be passed to find out what was in it. They didn't even know or understand what the lobbyists, insurance companies and big pharma had written for them.

Shows what a comprehensive plan it is. Yet we have nothing on the GOP plan, probably one line

Good Luck!
 
Trump is in good company. Obama, Reid and Pelosi leading the Dems who passed the ACA said it had to be passed to find out what was in it. They didn't even know or understand what the lobbyists, insurance companies and big pharma had written for them.

Shows what a comprehensive plan it is. Yet we have nothing on the GOP plan, probably one line

Good Luck!

You're uninformed. There are plenty of ideas currently being floated in addition to old plans and ideas being reviewed. I suggest you quit reading partisan sites and seek out information.
 
First off I'd like to say trump does not want health insurance for all, but access to health insurance for all, with lower deductibles. I firmly believe Trump knows nothing about Health insurance.

Copays the amount you pay when you visit a doctor , usually 25 for family and 50 for specialists
Deductible= when you meet the deductible then your plans pays 80/20 or even 70/30 or less depending on plan, this is called you coinsurance.
OOP is the important number, how much do you want to have to pay out of pocket before ins pays all.

Prior to the ACA, copays and medications were not covered in OOP max. Now if you have a condition, the major expense if follow up and twice a year visits to a specialist and perhaps many specialist.

Is this tiny nugget going to go away too??? and how it will affect you.

Read the below article:


Copay-based health plans prior to reform

Prior to healthcare reform, copays at the doctor or pharmacist did not count toward your deductible or out-of-pocket maximum. This wasn’t a huge deal for someone with low healthcare expense because a $35 copay here or a $10 copay there didn’t represent a lot of healthcare dollars.

However, this rule was a big deal for someone who was on multiple prescriptions and/or had numerous visits to the doctor. Why? Because this person was continually paying copays that didn’t ever get him or her any closer to meeting his or her deductible or out-of-pocket maximum.

Let’s take an example . Jake has a copay-based health plan with 80 percent coinsurance, a $2,000 deductible, and a $3,000 out-of-pocket maximum. After two doctor and three specialist visits, Jake is diagnosed with diabetes and told he needs to take two medications each month. Since Jake is on a copay-based health plan, he pays $25 for each visit to the doctor, and $40 for each specialist visit. The two medications will cost him $30 and $60 per month.

Therefore, Jake’s copays look like the following:

$50(2 doctor visits) + $120(3 specialist visits) + $360($30/month medication) + $720($60/month medication) = $1,250

This $1,250 does not count towards Jake’s deductible or out-of-pocket maximum. Why does this matter? Well, let’s say Jake gets in a car accident and has to be rushed to the emergency room for surgery. The medical bills from the emergency room total $17,000.

Jake is responsible for paying his deductible ($2,000) plus 20 percent of $17,000= $5,400

Jake’s out-of-pocket maximum is $3,000, so he’s responsible for paying $3,000 of the $5,400.

And this is all in addition to the cost of his copays, $1,250.

So Jake’s total medical bills for the year would be $1,250 (copays) + $3,000 (emergency room bills) = $4,250

Prior to reform, many people didn’t realize that copays were just empty payments that didn't count toward either the deductible or out-of-pocket maximum.

Healthcare reform has changed this, and now copays must count toward the out-of-pocket maximum. Let’s look at the rules post-reform.

- See more at: Do copays count toward the out-of-pocket maximum? The deductible?

My max out of pocket is $750/year and my premiums, because it's part of my compensation, is ZERO. What I don't need is the government fucking that up on behalf of some freeloader unwilling to provide to himself.
 
Trump is in good company. Obama, Reid and Pelosi leading the Dems who passed the ACA said it had to be passed to find out what was in it. They didn't even know or understand what the lobbyists, insurance companies and big pharma had written for them.

Shows what a comprehensive plan it is. Yet we have nothing on the GOP plan, probably one line

Good Luck!

You're uninformed. There are plenty of ideas currently being floated in addition to old plans and ideas being reviewed. I suggest you quit reading partisan sites and seek out information.

I have worked in this business long enough and had to self pay insurance for years so unless you know anything about the GOP plans please clue me in, because HI has been horrible since the mid 90's , and the GOP never did a thing about it, as a matter of fact many Rep states like Texas has the highest uninsured of any state.
Their ideas amount to nothing.
 
First off I'd like to say trump does not want health insurance for all, but access to health insurance for all, with lower deductibles. I firmly believe Trump knows nothing about Health insurance.

Copays the amount you pay when you visit a doctor , usually 25 for family and 50 for specialists
Deductible= when you meet the deductible then your plans pays 80/20 or even 70/30 or less depending on plan, this is called you coinsurance.
OOP is the important number, how much do you want to have to pay out of pocket before ins pays all.

Prior to the ACA, copays and medications were not covered in OOP max. Now if you have a condition, the major expense if follow up and twice a year visits to a specialist and perhaps many specialist.

Is this tiny nugget going to go away too??? and how it will affect you.

Read the below article:


Copay-based health plans prior to reform

Prior to healthcare reform, copays at the doctor or pharmacist did not count toward your deductible or out-of-pocket maximum. This wasn’t a huge deal for someone with low healthcare expense because a $35 copay here or a $10 copay there didn’t represent a lot of healthcare dollars.

However, this rule was a big deal for someone who was on multiple prescriptions and/or had numerous visits to the doctor. Why? Because this person was continually paying copays that didn’t ever get him or her any closer to meeting his or her deductible or out-of-pocket maximum.

Let’s take an example . Jake has a copay-based health plan with 80 percent coinsurance, a $2,000 deductible, and a $3,000 out-of-pocket maximum. After two doctor and three specialist visits, Jake is diagnosed with diabetes and told he needs to take two medications each month. Since Jake is on a copay-based health plan, he pays $25 for each visit to the doctor, and $40 for each specialist visit. The two medications will cost him $30 and $60 per month.

Therefore, Jake’s copays look like the following:

$50(2 doctor visits) + $120(3 specialist visits) + $360($30/month medication) + $720($60/month medication) = $1,250

This $1,250 does not count towards Jake’s deductible or out-of-pocket maximum. Why does this matter? Well, let’s say Jake gets in a car accident and has to be rushed to the emergency room for surgery. The medical bills from the emergency room total $17,000.

Jake is responsible for paying his deductible ($2,000) plus 20 percent of $17,000= $5,400

Jake’s out-of-pocket maximum is $3,000, so he’s responsible for paying $3,000 of the $5,400.

And this is all in addition to the cost of his copays, $1,250.

So Jake’s total medical bills for the year would be $1,250 (copays) + $3,000 (emergency room bills) = $4,250

Prior to reform, many people didn’t realize that copays were just empty payments that didn't count toward either the deductible or out-of-pocket maximum.

Healthcare reform has changed this, and now copays must count toward the out-of-pocket maximum. Let’s look at the rules post-reform.

- See more at: Do copays count toward the out-of-pocket maximum? The deductible?

My max out of pocket is $750/year and my premiums, because it's part of my compensation, is ZERO. What I don't need is the government fucking that up on behalf of some freeloader unwilling to provide to himself.

Good for you, and how much is your premium? Oh and those insured on the ACA are not freeloaders but mainly self employed or work for a company that does not have cost share insurance.
 
First off I'd like to say trump does not want health insurance for all, but access to health insurance for all, with lower deductibles. I firmly believe Trump knows nothing about Health insurance.

Copays the amount you pay when you visit a doctor , usually 25 for family and 50 for specialists
Deductible= when you meet the deductible then your plans pays 80/20 or even 70/30 or less depending on plan, this is called you coinsurance.
OOP is the important number, how much do you want to have to pay out of pocket before ins pays all.

Prior to the ACA, copays and medications were not covered in OOP max. Now if you have a condition, the major expense if follow up and twice a year visits to a specialist and perhaps many specialist.

Is this tiny nugget going to go away too??? and how it will affect you.

Read the below article:


Copay-based health plans prior to reform

Prior to healthcare reform, copays at the doctor or pharmacist did not count toward your deductible or out-of-pocket maximum. This wasn’t a huge deal for someone with low healthcare expense because a $35 copay here or a $10 copay there didn’t represent a lot of healthcare dollars.

However, this rule was a big deal for someone who was on multiple prescriptions and/or had numerous visits to the doctor. Why? Because this person was continually paying copays that didn’t ever get him or her any closer to meeting his or her deductible or out-of-pocket maximum.

Let’s take an example . Jake has a copay-based health plan with 80 percent coinsurance, a $2,000 deductible, and a $3,000 out-of-pocket maximum. After two doctor and three specialist visits, Jake is diagnosed with diabetes and told he needs to take two medications each month. Since Jake is on a copay-based health plan, he pays $25 for each visit to the doctor, and $40 for each specialist visit. The two medications will cost him $30 and $60 per month.

Therefore, Jake’s copays look like the following:

$50(2 doctor visits) + $120(3 specialist visits) + $360($30/month medication) + $720($60/month medication) = $1,250

This $1,250 does not count towards Jake’s deductible or out-of-pocket maximum. Why does this matter? Well, let’s say Jake gets in a car accident and has to be rushed to the emergency room for surgery. The medical bills from the emergency room total $17,000.

Jake is responsible for paying his deductible ($2,000) plus 20 percent of $17,000= $5,400

Jake’s out-of-pocket maximum is $3,000, so he’s responsible for paying $3,000 of the $5,400.

And this is all in addition to the cost of his copays, $1,250.

So Jake’s total medical bills for the year would be $1,250 (copays) + $3,000 (emergency room bills) = $4,250

Prior to reform, many people didn’t realize that copays were just empty payments that didn't count toward either the deductible or out-of-pocket maximum.

Healthcare reform has changed this, and now copays must count toward the out-of-pocket maximum. Let’s look at the rules post-reform.

- See more at: Do copays count toward the out-of-pocket maximum? The deductible?

My max out of pocket is $750/year and my premiums, because it's part of my compensation, is ZERO. What I don't need is the government fucking that up on behalf of some freeloader unwilling to provide to himself.

Good for you, and how much is your premium? Oh and those insured on the ACA are not freeloaders but mainly self employed or work for a company that does not have cost share insurance.

Those insured under Obamacare that get subsidies to help fund it are freeloaders.

As for your claim about who mostly is covered, where are your stats?
 

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