Penelope
Diamond Member
- Jul 15, 2014
- 60,265
- 15,790
- 2,210
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?
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?