Health Insurance With No Deductible And No Copay

Posted : admin On 1/2/2022
  1. If your Obamacare plan does not require a copay for a covered medical service, then your health insurance carrier will generally pay for the service, so long as you have already met your annual deductible for the year and assuming coinsurance does not apply under your plan.
  2. WASHINGTON — Democratic presidential candidate Bernie Sanders says his plan for a government-run health care system from cradle to grave is like Medicare for all. But with full coverage for.
Copay

The health insurance policy provides copay rules, such as when a copay is required and how much is paid for each type of provider, facility, service and procedure. Copay amounts often differ for visits to specialists and primary care physicians – or for care provided by different types of facilities.

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Is It Better To Have No Deductible For Health Insurance

What To Know About No-Deductible Health Insurance Plans

12/25/2018

There are many facets of any given health insurance plan, and finding the best plan is all about maximizing good features while minimizing ones you don't relish (like out of pocket expenses).

​One option that appeals to many for 2019 coverage, is typically found in the Individual Marketplace as a Gold Level plan, and that is the no-deductible health insurance policy, also referred to as an “all copay” plan.
Health Insurance With A Zero-Dollar Deductible
Anytime you increase the benefit in one area of a health plan, you can expect other areas to compensate to a degree. After all, health insurance may make health care affordable - but it can't be 100% free, except in a perfect world.
That said, many people dislike deductibles more than any other factor in a health plan and tend to zero in on zero-deductible policies like a magnet as soon as they hear of them. Low deductible plans tend to cost more than high deductible plans as per monthly premiums paid, and so zero deductible plans cost even more. But, these plans offer you coverage that is payable immediately, at time of service, with a fixed out of pocket amount (ie. a copay) so that you know exactly what to expect to pay before you even go in to receive health care.
Are There Still Out Of Pocket Costs Without A Deductible?
Yes, you will still have some out of pocket expenses even without a deductible on your health insurance plan, but they are fixed amounts. Consider these points:
  • With these plans some level of a copay will apply to all services rendered, except wellness care which is covered at 100% on all ACA compliant health plans.
  • The copay for each service rendered will differ depending on the type of healthcare being delivered. For example, a primary care doctor’s visit might have a $35 dollar copay while an Emergency Room might have a $250 copay, and something like an MRI, might have a $400 copay.
  • These plans also tend to offer copays during hospital stays but they usually cumulative, meaning your copay might be $600 per day with a three day charge maximum (meaning your total out of pocket for an inpatient hospital stay would be $1800, even if you’re in the hospital 10 days or run up over $200,000 in medical bills). In most instances, this means you have much less out of pocket exposure during a major health event, than you would have on a traditional plan with deductible and coinsurance.
  • Even with no-deductible plans, you will have an out of pocket maximum. When the plan offers all copays, this just means that as you pay your copays throughout the year, they will accumulate towards your out of pocket maximum. If you do have a catestrophic event with a variety of ongoing healthcare, you could still reach the maximum. And, when you do, your insurance will then pick up 100% of charges over and above that maximum for the remainder of the year, just like with traditional deductible plans.
Why Ever Get A Plan With A Deductible?
Someone may question at this point, why ever get a plan with a deductible, much less a high one?
First and foremost, the premiums will be much lower than they would be for a no deductible plan that offers you all copays at time of service. This is because when there is a deductible, and especially a high deductible, you are required to carry more of the cost sharing load up front, before your insurance even has to pay for services rendered. Many people use high deductible plans to save them money all year long in insurance premiums, understanding that “if” something major happened they would have more expense out of their own pocket at that time.
Second, with a high-deductible plan you can sometimes also qualify for a Health Savings Account, which allows you to put pre-tax dollars aside for future health needs. This too can be a very economical way for health individuals to build their healthcare fund and protect themselves against future unexpected health events, without it costing them quite as much now (while they may be more healthy and won’t be using the insurance quite as much).
Still not sure which type of plan is right for you? Contact Summerlin Benefits Consulting today and we can explain the options in greater detail.