Eli5: How does health insurance work in the U.S?

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I have been working for a new company for a year now, and have been on their insurance through Aetna the entire time. It’s the first time I’ve had health insurance through work.. So I’m paying monthly out of my check for the health insurance, but then im still going to owe my health provider out of pocket at the end of the year if i don’t pile up enough medical bills?

In: Economics

12 Answers

Anonymous 0 Comments

The details are plan specific, but you pay part of the premium, and your employer pays the rest.

When you use health care services, insurance pays a percentage, and you pay the rest. There is an out of pocket maximum per calendar year. Once you exceed that, insurance covers the whole bill.

So, if you break your arm, insurance pays whatever the policy covers, say 80%. If the bill is $2000, you owe $400.

If you get cancer and your treatment costs $200,000, your cost is capped at whatever your out of pocket maximum is, say $4000.

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