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Under the ACA, in and out of network must have the same cost sharing for ER care. It’s the risk you run having such a high deductible plan. But I’m sure you’ve
by CSactuary 7y ago
Under the ACA, in and out of network must have the same cost sharing for ER care. It’s the risk you run having such a high deductible plan. But I’m sure you’ve saved monthly by paying lower premiums for such a low coverage plan.
- red-indian 7y agoYou are responding to a post where he paid $7,900 for a $11,800 procedure. Under ACA Bronze, the worst plan, his copay should have been 40%. Is it your assertion that $7,900 is 40% of $11,800?
- CSactuary 7y ago? When you pay a % of the allowed amount that’s called coinsurance (not a copay). This is paid after deductible in most cases. So he would owe up to his deductible ($7,900) before his coinsurance would kick in. A minimum value ACA plan must have > 60% AV and cover the essential health benefits. The coinsurance % is irrelevant so long as it meets those requirements.