I am a 25 year old man who spent his 18-now in the military with tricare. I now have a job where I have to enroll in healthcare. What do I look for in a plan? What is a deductible? If I have a co-pay, do I still have to pay up to $8000 just to GET to my co-pay? Why did no one explain this to me?
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Your premium is what you have to pay to have the plan (usually paid monthly, but you’re signed up for the plan for a year.)
Your deductible is how much you have to pay before insurance kicks in. On some plans, that’s before they pay for almost anything. On other plans, they’ll say “deductible waived” for certain things like doctor visits. All plans have to provide preventive care at no cost, so a “well visit” once a year just to let the doctor make sure you’re doing as good as ever won’t cost you anything. Going in because you’re sick could cost you hundreds if you have to meet your deductible first or less than $100 (usually $15-55ish) if the deductible is waived. Sometimes prescriptions have a separate deductible.
That smaller cost for a sick visit would be a co-pay. Copays are when insurance has kicked in but you still share the cost, either as a flat fee or a percentage. There can be fees for visits, labs, medications, etc. Some copays are “automatic,” ie before you hit the deductible, and others you can only get to by first paying as much as your deductible is.
There’s also an out of pocket max, which is the most you would have to pay in a single year, even if your copays and other costs get billed for more than that. Your deductible should count towards it, but always check any footnotes or parenthesis for exceptions to any of this stuff.
You should be able to talk to someone if you have specific questions about a plan. If you’re going through your employer, talk to HR or see if they can check with the insurance company or their insurance agent or broker or someone like that.
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