But as you can see, there are far more services with a specified copayment or coinsurance percentage, not subject to the deductible, than health care services subject to the medical deductible. It’s possible to meet your maximum out-of-pocket amount without ever meeting the medical deductible.
Posts related to coinsurance as an element of cost sharing for the health insurance plan member.
The big change for the Gold plan was an increase in the MOOP from $6,000 in 2018 to $7,200 in 2018. That is a 16% increase. Before 2018, the Gold plans did not make a lot of financial sense considering they were so much more expensive than Silver plans. In 2018 the Gold plan MOOP was reduced to $6,000 and the Silver plans offered through Covered California were artificially inflated by approximately 10%. This meant for consumers receiving very little monthly tax credit subsidy, they were better off enrolling in a Gold plan because for some carriers the rate was less than the Silver plan.
One of the most baffling health plan descriptions is the 2016 Bronze 60 health plan that states that the member is responsible for 100% coinsurance after the deductible. Most people who read this immediately shake their head and think, “I have to pay for all of my health care services EVEN AFTER I meet the deductible?” There really is no reason to buy health insurance if it never helps with the costs. The second part of the equation, not always referenced, is the calendar year maximum out-of-pocket amount of the Bronze plan which does limit a health plan members health care expenses.
The confusion over the colonoscopy billing is detailed in a new report Coverage of Colonoscopies Under the Affordable Care Act’s Prevention Benefit.