General Discussion
In reply to the discussion: trying to figure out where I'm going to get the money for my obamacare [View all]TheKentuckian
(26,314 posts)With some plans you will pay 100% of the negotiated rates up to the deductible.
Some plans the deductible applies to the out of pocket, other plans they accumulate separately.
Generally, care beyond those visits with structured copays on the better plans still require the deductible be reached.
I see plans with drug "coverage" where you would always pay 100% of the negotiated rate and the benefit is getting the negotiated rate.
I've seen horrible plans with 10k deductibles, 50% coverage, and another 15k to the OOP. One time I came across similar coverage with a 25k OOP.
Even higher earners cannot actually afford care, especially ongoing care and end up gobbling up charitable funds to actually get treatments because all folks tend to focus on is premiums.
Sorry, there is no one answer. Plan structures vary wildly not just by carrier but by group as well. Almost all current individual policies are complete garbage (in my opinion) and this is where for many the Wealthcare and Profit Protection Act is something like affordable care. Most folks are not in the individual market so their experiences are very different so the benefits are not broad by definition but for this 15% of the population this is big in a rubber meets the road way while for most of the population the benefits are less clear and for relatively young folks that make something like living wages matters will appear worse unless they have catastrophe because most folks are already paycheck to paycheck and not loving life so any increase isn't exactly "affordable" to them no matter if you can get some screenings included with your premium.
One thing is sure, we'll continue to have the most fucked up and expensive system in the civilized world and people will keep on avoiding care for financial reasons.