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Recursion

(56,582 posts)
Wed Mar 26, 2014, 12:54 AM Mar 2014

How common is this "the deductible equals the out of pocket maximum" thing?

I'm seeing this a lot in DUers posting their plans and it just seems bizarre to me. Is coinsurance as a concept just going away? It's still weird for me to see that called a "deductible".

I've also seen a few people with a pretty problematic misunderstanding. Once you reach your out of pocket maximum, there's no "60%/40%" or anything like that. Your OOPM is your OOPM; that is all you will ever have to pay for the treatments you receive that year.

The idea once upon a time was that you paid a relatively small deductible (mine was usually in the range of $500 or so) at which point coinsurance would kick in. The plan would pay a percentage of your expenses up to an out of pocket maximum, at which point they'd take over and pay anything. If this thing with the deductible also being the maximum is as common as it seems (it's been every bronze plan anyone has posted that I've read here), then it looks like coinsurance is going away, at least for the exchange plans. I'm not sure why; it seems like a good way to do things. But maybe it's too complicated?

Also, as a final thought, the "60%/40%" or whatever that your plan may have does not describe how much you as an individual have to pay. That division means that the plan should be designed to, on the whole, cover 60% of their policyholder's medical expenses. The deductibles, maximums, etc. that they set are calculated to get them to that percent. If your deductible is your out of pocket maximum (and like I said, that's been every exchange plan I've seen people post the details of), then there's never a situation where you're paying some percent of a bill. You pay the bills in full until you reach your "deductible", at which point the insurer takes over completely.

Anyways, I think the term "deductible" is confusing in this case (at least to me) and I just wanted to see how common that actually is, if anybody knows.

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