Not quite, at least not in American healthcare terms. A copay is your portion of the cost for an appointment, procedure, or prescription. For example of the doctor visit is $100 and my copay is $25, I pay $25 and the insurance pays $75 (in practice the insurance doesn’t ever really pay their full share but that’s a more complicated part of the equation.)
The deductible is how much I have to pay out of pocket in a year before the insurance starts paying anything. My deductible might be say, $1000, meaning I have to pay $1000 out of pocket before the insurance kicks in to cover anything at all.
max out of pocket is the maximum amount you will pay for medical in a year.
Oh and of course there is the premium which you pay monthly for the pleasure of having insurance.
So if your premium is $200, copay is $25, your deductible is $1000, and your max out of pocket is $5000, and a (normal non specialty) doctor visit is $100, you have to visit the doctor 10 times before the insurance pays anything at all (you pay the full $100 each time) and then the 11th visit is $25 and the insurance pays the rest. If you visit the doctor enough to hit max out of pocket (160 more visits to a normal non specialty doctor), then the insurance kicks in to pay 100%. And no your monthly $200 premium doesn’t go towards your max out of pocket
Most people never hit their max out of pocket and most people without kids that Ive talked to never hit their deductible unless they have a condition that requires regular treatment or if they get into an accident or have something major happen. Then you can blow out your deductible / max out of pocket in one hospital visit.
So basically your insurance is paid to do diddly squat, except prevent you from going bankrupt if you get into a car accident (except they will totally find ways to deny your claim anyways).
Source: am a trans man with a neurological condition. I’m a medical nightmare and have had to learn to be a self advocate through multiple American insurances.
dragonlover@lemmy.zip 9 hours ago
Not quite, at least not in American healthcare terms. A copay is your portion of the cost for an appointment, procedure, or prescription. For example of the doctor visit is $100 and my copay is $25, I pay $25 and the insurance pays $75 (in practice the insurance doesn’t ever really pay their full share but that’s a more complicated part of the equation.)
The deductible is how much I have to pay out of pocket in a year before the insurance starts paying anything. My deductible might be say, $1000, meaning I have to pay $1000 out of pocket before the insurance kicks in to cover anything at all.
max out of pocket is the maximum amount you will pay for medical in a year.
Oh and of course there is the premium which you pay monthly for the pleasure of having insurance.
So if your premium is $200, copay is $25, your deductible is $1000, and your max out of pocket is $5000, and a (normal non specialty) doctor visit is $100, you have to visit the doctor 10 times before the insurance pays anything at all (you pay the full $100 each time) and then the 11th visit is $25 and the insurance pays the rest. If you visit the doctor enough to hit max out of pocket (160 more visits to a normal non specialty doctor), then the insurance kicks in to pay 100%. And no your monthly $200 premium doesn’t go towards your max out of pocket
Most people never hit their max out of pocket and most people without kids that Ive talked to never hit their deductible unless they have a condition that requires regular treatment or if they get into an accident or have something major happen. Then you can blow out your deductible / max out of pocket in one hospital visit.
So basically your insurance is paid to do diddly squat, except prevent you from going bankrupt if you get into a car accident (except they will totally find ways to deny your claim anyways).
Source: am a trans man with a neurological condition. I’m a medical nightmare and have had to learn to be a self advocate through multiple American insurances.
SchmidtGenetics@lemmy.world 9 hours ago
In other places, a deductible is what you pay to get insurance coverage for an event. So yes, it is essentially that to the rest of the world.