How Do Deductibles Work With ObamaCare?

If there is a six thousand dollar deductible, does that mean I pay all of that no matter how many doctor visits before insurance kicks in?

How am I expected to afford six thousand dollars in deductibles if they have already determined I can only afford 135.00 a month at my income?

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Daughter-in-law has broke her wrist. She says she has a free obama care policy with a $36,000 deductible. She says she must pay all her medical bills up to $36,000 before she has insurance. Can this be correct?


That is not correct, the ACA put a limit on out-of-pocket deductibles and maximums on all major medical health plans. So unless she got short term instead of a plan (and thus did not get “ObamaCare”), this is incorrect.

For 2019, your out-of-pocket maximum can be no more than $7,900 for an individual plan and $15,800 for a family plan before marketplace subsidies.

NOTE: She may have a $3,600 deductible, but even then, it doesn’t make sense that her plan wouldn’t have to pay the entire amount before having insurance, she would have co-pays and the insurer would eat many costs up front even on the lowest benefit bronze plan.


Totally confusing . GIVE US EXAMPLES I


I’m confused, I chose the silver plan with Molina, at $109. a month with tax credit applied. Why is my initial payment $571.86? I received the applied tax credit because I can’t afford the full amount the insurance would of been. So how would they expect me to pay the initial of $571.86? I can’t pay that!


The health insurance I’m thinking of choosing says “$25. copay after deductible. I’m trying to figure out what that means. Most other plans just say the copay, without saying after deductible, do I still pay $25., or does that mean after I pay all the $5000 deductible, which I can’t.
Thank you.


It means you owe 100% of costs (or % per the terms of the plan) before you pay off the deductible and a fixed $25 per time you access the service after.

So yeah, essentially it is “after the $5,000 but before the maximum”.

I’ll be honest, i’ve never looked at the number and thought, “I can’t understand why people get upset”. $5,000 is a lot!


yes…I DO believe u need to pay down WHATEVER ur dedudtible before you’re even eligible for copays!!? INSANITY!!!!


Obama Care is a joke, it is no more than a way to make insurance company’s wealthier, by using tax payers money to pay the premiums for people who cant afford it. Who can afford to pay the first six thousand dollars before the insurance kicks in, completely ridiculous. I’s sure Obama is getting his pockets lined with plenty of money for coming up with this scam.


You are an idiot! Stop listening to right wing talk radio drivel and engage your brain!

Hey, I’ve been paying YOUR health insurance premium every time I put gas in my car, buy food, pay the electric bill, etc.

…which you probably get for FREE through your job.

I am self employed. My health insurance would be $500 a month without Obamacare. With Obamacare, it’s $50.

How much do YOU pay? Zero, right?

Nobody buys heal care directly. Not even YOU.


Yes, but how much is your deductible?


That is not how it works you stupid sheep. You only pay a portion of your deductible per visit depending n the kind of care. For routine/preventative coverage you pay NO deductible at all. You do NOT have to pay the entire deductible before insurance covers anything, you and the insurance company share costs, average 70%insurer/30% insured, until your 30% reaches that total deductible. If you are not sick often it will barely cost you anything, if you are chronically sick it will save you THOUSANDS (tens of thousands even, maybe more) of dollars. This is not a new concept, it is exactly how it worked pre-ACA except the costs were going up even faster every year.

If you were to get in a car accident and have to spend the night in an ER Trauma unit, your bill would likely be over $15,000. If you did only co-pay type insurance you would be responsible for approximately 20-25% and insurance would pay the rest. In this example your cost is $3750, for one night. If you spend 2 nights, then it is $7500.

If you have a deductible of 5-6k, that is all you would pay FOR THE ENTIRE YEAR and then insurance is responsible for everything except co-pays. So would you rather keep paying the insurance company? What if you spent a week in the ER? Can you afford $26,250 dollars out of pocket? Or would you rather pay $6000 and not worry about your family becoming homeless because of health issues?

Deductibles are not new, they were only slightly lower before the ACA and we didn’t hear your whining then. Neither are HSA’s, which republicans claim will replace deductibles and come from magic fairy land and not your pocket. An HSA is nothing more than a Health SAVINGS Account, meaning you have to SAVE your money, usually by automatic withdrawal from your Pre-tax paycheck. Now this does save you money because you wont pay taxes on what you use, but if you don’t need/use it you will be assessed taxes on that money at the end of the year, potentially giving you a big bad surprise that you OWE the IRS at the end of the year. On another important note THESE ALREADY %$3*(*# EXIST and you can use them for the EXACT same savings if your health plan offers it, most all ACA plans do. So stop listening to Faux News and Trump’s babbling and go talk to your insurance company or any other medical billing office and ask them to explain it to you. Under the ACA they are required to explain your benefits to you if you ask for help, so if you want to not be a $#$$%, go ask.

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