For instance, they might pick up part of the cost of a few primary care doctor visits a year even before you've spent to the limit of your deductible. This being American health care and therefore needlessly complicated, some plans provide some services "outside" the deductible. If you have outpatient surgery, the plan might pay 80 percent and you'll pay the other 20 percent (this is called coinsurance). If you go to the doctor, you might pay a flat $30 (this is called a copay) and the plan will pay the rest of the bill. At that point, your plan will start paying some share of the expenses. If, for instance, you buy a plan with a $2,500 deductible, you will pay for the first $2,500 of your medical expenses yourself. It's the amount you have to pay out of your own pocket before your health plan's benefits kick in. But there is a difference, a big one, and you need to understand it in order to make an intelligent choice of insurance plan. Like many if not most people shopping for insurance on their own, the makeup artist didn't know the difference. "I might as well not have insurance at all."Īctually, no Gold plan could possibly have a $6,000 deductible, as I'll explain in a minute, but the plan almost certainly had a $6,000 out-of-pocket limit. "I was looking at a Gold plan and it had a deductible of $6,000," she said. The other day I was talking with a young self-employed makeup artist who was shopping for insurance on DC Health Link, the insurance marketplace for Washington, D.C.
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