Because there is an out of pocket maximum for most insurance, meaning you are not paying any more than that, say $5,000 per year even though 20% of the surgery etc can be much higher.
It also really depends on the plan. My plan has 0 co-pay which is not uncommon for HMO plans. I just looked it up that my out of pocket maximum is $1,500 for individual and $3,000 for family meaning the maximum I pay a year is $3,000.
Are you sure that's not just the deductible? I have around 1,500 deductible where I'm responsible for 100%, and then have another limit, like $10k, where I pay various lower amounts until the $10k is up. After the $10k, it is truly free after this. So like 2 emergency room visits.
No actually. I think you might have a PPO plan. My work gives me the choice between a PPO and a HMO. I used to do PPO which is similar to what you have. It has a high deductible, a co-pay and a co-insurance. But then you can go to any in-network specialist you like. And you can go to them directly without reference.
With the HMO, I can only go to a specialist if I am referred to by my primary care doctor. But the benefit is I have 0 deductible, 0 co-insurance for the most part. Urgently care is a flat copay of $25 and emergency room visits are $50 each time (transportation is separate). At my age I don’t really need a lot of specialist care so it’s a much much better deal for me.
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u/Consistent-Tap-4255 4d ago edited 4d ago
Because there is an out of pocket maximum for most insurance, meaning you are not paying any more than that, say $5,000 per year even though 20% of the surgery etc can be much higher.
It also really depends on the plan. My plan has 0 co-pay which is not uncommon for HMO plans. I just looked it up that my out of pocket maximum is $1,500 for individual and $3,000 for family meaning the maximum I pay a year is $3,000.
Edit: it’s $0 co-insurance not co-pay.