A lot of plans on the marketplace have the same number for deductible and for out-of-pocket maximum. For example, both might be $5000.
It’s my understanding that (assuming everything is in-network) if you haven’t yet reached your deductible, you have to pay 100% of any expenses. And then once you reach the out-of-pocket maximum, the insurance covers everything and you pay for $0.
Normally you would pay a copay for expenses after you meet your deductible but before you’ve reached your OOPM for the year. That makes sense. But I can’t figure out why there would be a copay listed on the plan (for office visits/prescriptions) when the deductible and OOPM are the same amount.
Under what scenario would you pay a copay? Since copay numbers are listed in the plan details, they must be there for a reason, so I assume there is something that I am totally misunderstanding.
submitted by /u/reindeermoon
[link] [comments]
A lot of plans on the marketplace have the same number for deductible and for out-of-pocket maximum. For example, both might be $5000. It’s my understanding that (assuming everything is in-network) if you haven’t yet reached your deductible, you have to pay 100% of any expenses. And then once you reach the out-of-pocket maximum, the insurance covers everything and you pay for $0. Normally you would pay a copay for expenses after you meet your deductible but before you’ve reached your OOPM for the year. That makes sense. But I can’t figure out why there would be a copay listed on the plan (for office visits/prescriptions) when the deductible and OOPM are the same amount. Under what scenario would you pay a copay? Since copay numbers are listed in the plan details, they must be there for a reason, so I assume there is something that I am totally misunderstanding.
submitted by /u/reindeermoon [link] [comments]Read Morer/HealthInsurance