Deductible vs. Out of Pocket Max
- May 24, 2021
- 8:22 pm
To make a complicated subject simple, insurance plans cover some costs until you reach your deductible and it covers all the costs once you meet your out of pocket maximum. But it’s usually not that clear cut and here we will address some of the common questions and confusions on the topic.
What is a deductible? A deductible is a specified amount of money that the insured must pay before an insurance company will pay a claim. Now this does not mean that you are responsible for all the cost of your health care until the deductible is met because your plan may have copays or other options as well.
What costs do not apply to my deductible? Your health insurance premiums, copays, and any health care not covered by insurance.
What is an out of pocket max? The most you will have to pay for covered health care services in your policy’s plan year. Once you have met your out of pocket max, you will not be required to pay any further healthcare costs. The one cost you are still responsible for is your monthly insurance premium.
What about in-network and out-of-network deductibles? On many health plans they will have two different deductibles, one for in-network services and one for out-of-network services. It’s almost always in your best benefit to use services that are considered in-network as your plans out-of-network deductible is usually twice the cost.
One of the benefits of a health plan from ACBA, there are no networks with out health plans. These plans use a format called Reference Based Pricing that allow us to offer health insurance without being restricted by networks.
Unhappy with your current deductibles or plan design? ACBA plans are available to anyone, all across the country. If you want more information, then reach out to us here and someone will get back to you shortly!