<p>
On average. Including subsidies.</p>
<p>I never thought mine would go down. </p>
<p>I’m just having sticker shock that it has tripled for less coverage.</p>
<p>“The 60/40 (or whatever) copay only starts AFTER you have spent your full deductable and then applies until you have hit the full max annual out of pocket.”</p>
<p>A co-pay is a set amount one pays for a service. For example, one pays $20 each time you visit the doctor and the insurance company pays the rest of the bill (usually a negotiated price between insurer and provider.) Co-pays normally do not count as out-of pocket expenses or towards your deductible. </p>
<p>60/40 or the more common 80/20 is co-insurance. The insurance company pays the larger percentage of a bill and the insured pays the smaller percentage. </p>
<p>For instance, if you have 60/40 co-insurance and the bill for an MRI is $1000, you would pay $400 and the insurance company pays $600. The $400 would count towards your deducible. </p>
<p>I am going to have to go do some research to see if the plans work the way you say they do.</p>
<p>The regional differences seem extremely random. Mine is no more expensive but has double the deductible. No like!</p>
<p>The bottom line is, the US spends a whole lot more per person for health care than any other country, without getting better health care on many measures. Health care in the US costs a lot. And so if we’re going to provide health insurance to everyone someone has to pay. And unfortunately in the system we picked, poetgrl is subsidizing people older and sicker than she is. </p>
<p>Of course, all of us are subsidizing people older and sicker than we are, because we’re all paying for Medicare, which costs a fortune. About 20% of your federal taxes go to Medicare, Medicaid and CHIP.</p>
<p>But poetgrl and others in her situation are also having to subsidize the under-65 old and sick. I’m subsidizing them too, but at least I get a tax deduction for it.</p>
<p>From what I can tell, the deductible has to be met but after that the insured only pays the co-insurance percentage, until the out of pocket max is reached. Then the insurance company pays 100%.</p>
<p><a href=“https://www.healthcare.gov/glossary/co-insurance/[/url]”>https://www.healthcare.gov/glossary/co-insurance/</a></p>
<p>“Your share of the costs of a covered health care service, calculated as a percent (for example, 20%) of the allowed amount for the service. You pay coinsurance plus any deductibles you owe. For example, if the health insurance or plan’s allowed amount for an office visit is $100 and you’ve met your deductible, your coinsurance payment of 20% would be $20. The health insurance or plan pays the rest of the allowed amount.”</p>
<p>
that’s the problem, 30m will still be uninsured…if not more.</p>
<p>Soon we will all be old, sick, and poor. And there will be no money left for subsidies.</p>
<p>emilybee, the HSA plans require you to meet full deductible, there is no coinsurance. These are the cheapest plans.</p>
<p>My plan is silver. Meet your deductible and then they start to pay. Not one dollar before that, except the regular physical.</p>
<p>and there are HSA plans for gold, silver and bronze, at least in my state there are</p>
<p>If a plan has an actuarial value of 60%, that means that the insurance company pays 60% of all the covered medical care that all the subscribers to that plan get. But that includes all the care that is covered 100% because the person has met the out-of-pocket limit.</p>
<p>If the insurance company paid 60% from the first dollar up until the subscriber had met the out-of-pocket limit, and then 100% thereafter, that could not average to 60% of all the care.</p>
<p>Deleted post since other post was edited.</p>
<p>Deductibles are met, then the rest is paid using coinsurance. If there is an “out of pocket maximum” the amount you pay as coinsurance plus your deductible add up,to meet the out of pocket max. After that everything is paid I full. Not sure if these exchange plans have an OOP maximum.</p>
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</p>
<p>You are mistaken. The California Bronze plans require the deductible to be reached before the co-pays kick in. The basic Bronze works like this for an individual policy:</p>
<ul>
<li>Preventive care covered immediately, at no cost </li>
<li>$5000 deductible</li>
<li>After $5000 deductible met, patient has set copay, which is applied to the deductible, up to $1350 more, until the $6350 out-of-pocket max is reached.</li>
<li>From then on, insurance pays 100%</li>
</ul>
<p>The California Bronze HSA’s work like this:</p>
<ul>
<li>Preventive care covered immediately, at no cost </li>
<li>$4500 deductible</li>
<li>After $4500 deductible met, patient pays 40% of all expenses, which is applied to the deductible, up to $1850 more, until the $6350 out-of-pocket max is reached.</li>
<li>From then on, insurance pays 100%</li>
</ul>
<p>California’s exchange is standardized, so each insurance companies policies on the exchange have identical benefit structures.</p>
<p>The policy structures can differ in other states. The law requires that all plans cover the essential benefits, and that the metal tiers have a set actuarial value – but there is considerable flexibility as to how to meet that actuarial value. </p>
<p>And yeah, you will find that you can get much better and more affordable insurance in some states than in others. If we could have had a public option (Medicare for all), then maybe premiums would be set according to a national standard, and those of us in the states that are on the short end of the stick in terms of exchange offerings might have another choice.</p>
<p>^wow that stinks if true. I thought all HSA plans in every state pay 100% after deductible is met.</p>
<p>njfootballmom – all exchange policies, and all new policies issued after Jan. 1 have a $6350 out-of-pocket maximum for individuals, $12,700 out-of-pocket for families. That’s the law – it will not be possible to buy a new policy after Jan 1 with a higher out-of-pocket max. (But that wouldn’t necessarily apply to grandfathered plans, including most employer-provided plans)</p>
<p>Links: [Out</a> of pocket maximums and the 2014 transition year - Lexology](<a href=“Out of pocket maximums and the 2014 transition year - Lexology”>Out of pocket maximums and the 2014 transition year - Lexology)</p>
<p><a href=“http://www.dol.gov/ebsa/faqs/faq-aca12.html[/url]”>http://www.dol.gov/ebsa/faqs/faq-aca12.html</a></p>
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</p>
<p>You have the concept of “deductible” confused with the “out-of-pocket maximum”.</p>
<p>In the higher metal tiers, many of the exchange plans have no deductibles at all. In California, the Platinum plan has no deductible and only a $4000 out of pocket maximum – but you would definitely be paying the difference between the $4000 and $6350 in the premium for that plan.</p>
<p>^ no, I don’t have them confused, I just thought other states would be the same as mine. All HSA plans, either Gold, Silver or Bronze pay 100% after the deductible is met. There are no copayments or coinsurance with these plans.</p>
<p>“You are mistaken”</p>
<p>Yes, I realized that after, which is why I deleted my post.</p>