I'm shopping for health insurance. (U.S., federal exchange, I'll be losing COBRA which is a qualifying life event.) One of the plans describes its emergency room costs as:
$100 Copay before deductible/40% Coinsurance after deductible
This makes no sense to me. When coverage is described relative to a deductible, I presume I'm responsible for 100% until I hit the deductible.
Let's say I got a $2000 ER bill.
- If I haven't yet met the deductible, I'd be responsible for all $2000.
The above description seems to say:
- If I haven't met my deductible, I'm responsible for a $100 copay.
- If I have met my deductible (but not my maximum out-of-picket), I'm responsible for 40% * $2000 = $800.
It makes no sense to me that my responsibility would be smaller before I met my deductible than after.
How would this really work?
(Added later) (but turns out to be irrelevant) Here are examples of how a similar plan ("$100 Copay before deductible/30% Coinsurance after deductible") works, using the two standard coverage examples:
- Amount owed to providers: $7,540
- Deductibles: $2,000
- Copayments: $20
- Coinsurance: $740
- Limits or exclusions: $150
- Total paid by patient: $2,910
(I have no idea how a plan with a $100 copay ends up in this example with a $20 copay. $740 is 30% of $2,466.67; I don't see where that number comes from.
- Amount owed to providers: $5,400
- Deductibles $2,000
- Copayments $400
- Coinsurance $440
- Limits or exclusions $80
- Total $2,920
(Similar mysteries apply.)