Welcome to DU! The truly grassroots left-of-center political community where regular people, not algorithms, drive the discussions and set the standards. Join the community: Create a free account Support DU (and get rid of ads!): Become a Star Member Latest Breaking News General Discussion The DU Lounge All Forums Issue Forums Culture Forums Alliance Forums Region Forums Support Forums Help & Search

Maraya1969

(22,462 posts)
3. There a maximum "out of pocket" spending limit for the insured that is $5,000
Tue Nov 4, 2014, 02:21 AM
Nov 2014

So how can you hit that limit and then be responsible for the first $7,000?


I checked another one that said it had a $7,000 and at the bottom notes it says:

HII-HealtheMed
HealtheMed STM 6 Months
Plan Brochure
MONTHLY PRICE
$285.55
Copay N/A
Deductible $7,500
Family Deductible $22,500
Coinsurance 50%
Coinsurance Limit $5,000
Network
Emergency Room 50% after deductible; Extra $250 deductible applies for Sickness visits if not admitted
And then it said this:

"Out of Pocket Maximum Individual: $5000; Family: $5000"


I think I remember someone explaining how this happens. The $7,000 could be for the year and divided by 12 to get each month's deductible.

But that still does not explain why there is an out of pocket maximum of $5,000

If true... ugh. nt MannyGoldstein Nov 2014 #1
The (roughly) $6000 in co-pays/deductibles that are required in addition to the monthly kelly1mm Nov 2014 #2
There a maximum "out of pocket" spending limit for the insured that is $5,000 Maraya1969 Nov 2014 #3
ACA limit is $6600 for individual OOP max in 2015 ($13,200 for family). So, depending kelly1mm Nov 2014 #4
It means -- Nuclear Unicorn Nov 2014 #5
They won't kill strawberries Nov 2014 #11
Why would they kill it if they can use it as a cudgel against the Dems? Nuclear Unicorn Nov 2014 #12
Yesterday I listened to a radio program about the enrollment period and Vinca Nov 2014 #6
My "provider" dropped out of the exchange. 99Forever Nov 2014 #7
"Sure am fucking glad we didn't get suckered into a single payer system or a public option." Nuclear Unicorn Nov 2014 #8
Can you tell us what your premiums deductibles and co-pays were if you include what your company Maraya1969 Nov 2014 #18
My company? $0 99Forever Nov 2014 #19
Obamacare is so ambiguous...could this reflect changes in employment & benefits HereSince1628 Nov 2014 #9
You can lead a horse to water........ Youdontwantthetruth Nov 2014 #10
How? zipplewrath Nov 2014 #14
The President Choose this course of action over Single Payer Youdontwantthetruth Nov 2014 #17
Did you puff out your chest and light one up for Rush while typing that? nt. NCTraveler Nov 2014 #15
Almost as good as "Die Quickly" n/t BuelahWitch Nov 2014 #16
Looks like prices are set to decline, so these folks will be pleasantly surprised. stevenleser Nov 2014 #13
Latest Discussions»General Discussion»What does it mean to say ...»Reply #3