When Do doctor co-pays on come in to play

[modhatter]

Not ever having a deductible before, I am new at this. I thought when a policy lists a co-pay such as $40 for your GP or $100 for Specialist, or $60 for Urgent care, $300 MRI costs, drug costs etc. that the co-pay or these set amounts listed for scans, prescriptions etc. only came into play after you paid full cost of services or drugs up to your deductible limit.

While on the the phone today with a sales person, she stated no that was not true. That the deductible is only for things related to hospital stays.
I don't know if she doesn't know what she is talking about, or if I got it all wrong. Someone please, straighten this confused person out.

This not an HSA policy.

[audreyh1]

Quote:

Originally Posted by modhatter Not ever having a deductible before, I am new at this. I thought when a policy lists a co-pay such as $40 for your GP or $100 for Specialist, or $60 for Urgent care, $300 MRI costs, drug costs etc. that the co-pay or these set amounts listed for scans, prescriptions etc. only came into play after you paid full cost of services or drugs up to your deductible limit. While on the the phone today with a sales person, she stated no that was not true. That the deductible is only for things related to hospital stays. I don't know if she doesn't know what she is talking about, or if I got it all wrong. Someone please, straighten this confused person out. This not an HSA policy.

It is the other way around from what you thought. The co-pay are fees you pay for certain specific services up to your deductible after which your coinsurance rate takes over. This usually limits what you would otherwise have to pay for a specific service - i.e. it is much cheaper up front.

For plans with no copays - you pay the full negotiated price for any medical service up to the deductible, then you pay their coinsurance rate up to their max OOP.

Plans with copays are not HSA eligible.

[Animorph]

Quote:

Originally Posted by audreyh1 For plans with no copays - they pay the full negotiated price for any medical service up to the deductible, then they pay their coinsurance rate up to their max OOP. Plans with copays are not HSA eligible.

For plans with no copays - you pay the full negotiated price for any medical service up to the deductible, then you pay their coinsurance rate up to their max OOP.

The ACA has standards for all this I believe.

[audreyh1]

Quote:

Originally Posted by Animorph For plans with no copays - you pay the full negotiated price for any medical service up to the deductible, then you pay their coinsurance rate up to their max OOP. The ACA has standards for all this I believe.

I meant "they" as in the customer - but I corrected it to be clear. Thanks!