ACA Plan question, The hell does "with deductible" mean

Iruka

I'm making a spreadsheet of all of my options because I'm an adult and the .gov website still sucks. In scrutinizing plans I have come across this:

What does "with" mean, in this situation? A plan from the same provider specifies AFTER deductible clearly:


I assume that the Drugs and PCP prices with no other caveats mean "this it what these cost with the plan before deductibles". Is this just inconsistent copy?

zepherin

You pay the negotiated rate for the service until you reach the deductible then you pay the copay.

So if you see a foot doctor. His rate he charges Joe Six pack is 300 bucks, but the insurance company has an agreement to only pay 160 bucks.

So you pay 160 bucks until you meet your deductible then you pay 50 bucks a visit.

Usually you see this on high deductible plans.

Iruka

Isnt that "after deductable"?

zepherin

Iruka wrote: »

Isnt that "after deductable"?

Hrmmm, I always thought copay before deductible was you pay the copay and then you pay for the service up until the deductible. And copay with deductible was the same as after deductible.

I googled it and I've received both answers...insurance is complicated I'll ask my brother he does insurance billing.

Edit His answer:"depends on the provider, the copay either counts towards the deductible or it doesn't, but each insurance company makes their own decisions so it could be either."

Iruka

Hmm alright. I knew I needed to dig into the fine print of each individual plan, but I guess I should add "Does Copay count towards deductible?" as a slot on the sheet. Thanks to you and your bro for the help.

ArbitraryDescriptor

It might help to know which is more expensive?

Copay with deductible might mean you pay the copay before (and after?) you meet the deductible. After deductible might mean you only do the copay after its met. I would expect the former to cost more if it's copay ONLY, less of it's in addition to.

Iruka

@ArbitraryDescriptor

The "IdealCare" plans in this image were the ones I was referring to above. When I kept moving down the list, Blue cross uses the same syntax, but specifies the copay afterwards:

(The sheets still messy, sorry)

SO I assume "with" simply means I'm paying that before the deductible. Trying to figure out if those copays count towards the deductible will happen when I get back to this after work.

Simpsonia

My best guess is that is how they are wording copays that run at the time of service, without having met the deductible, but the distinction being that they might actually apply to your deductible. Most policies, at least that I've had, don't allow standard copays to actually apply to your yearly deductible (such as standard MD-office visits, etc).

However, the only way to know for sure is to just call up the provider and ask.

mts

i think you always pay the copay. if you have a deductable you pay up until that on top after deductable. once you hit that, you just do copay

Mr Obersmith

That wording sure is odd. I work for a health insurance company and my best guess is "after deductible" is what's been described above, that you pay the contracted rate for the service until you've met the deductible and then you pay just the copay after you meet your deductible. "With deductible" means that the copay applies to the deductible. We offer plans that handle it that way.