![]() ![]() The insurance company makes me responsible for a $100 copay for this first trip during my coverage period. Oh, well, sometimes that can't be avoided. Yes, this is an unusual case where my responsibility is smaller before meeting the deductible than after. I spoke to someone at the relevant insurance company. (The language "before deductible," though accurately transcribed, is misleading.) After that, ER trips start costing real money. Summary: The first ER trip is free (well, cheap). $740 is 30% of $2,466.67 I don't see where that number comes from. ![]() (I have no idea how a plan with a $100 copay ends up in this example with a $20 copay. (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: It makes no sense to me that my responsibility would be smaller before I met my deductible than after. If I have met my deductible (but not my maximum out-of-picket), I'm responsible for 40% * $2000 = $800.If I haven't met my deductible, I'm responsible for a $100 copay.If I haven't yet met the deductible, I'd be responsible for all $2000.When coverage is described relative to a deductible, I presume I'm responsible for 100% until I hit the deductible. $100 Copay before deductible/40% Coinsurance after deductible (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:
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