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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Different plans have different benefits. Premiums are what you pay on a monthly basis regardless of what you use – generally speaking higher premium means a lower deductible and maximum out of pocket cost.
A deductible is how much you have to pay before you insurance starts covering things, and a max out of pocket cost is how much you pay before they cover everything for the rest of the year.
Another thing to consider is that in-network and out-network are different things. In-network providers are the preferred health systems where your insurance provider has some negotiated deal with, out-network providers are ones where they haven’t done that. So you’d be able to meet your max out of pocket cost for in-network but if you had to use out-network care systems you’d need to start meeting that goal before they’d cover it.
Also FSAs and HSAs exist. An FSA is a flex spending account, when you sign up for insurance you’re able to opt to put in x amount of pre-tax money towards this if you know you’re going to hit your out of pocket max for the year. The downside to FSAs is that the money *has* to be used by the end of the year or it disappears. You can use it for all sorts of things though, and there are specific FSA lists of stuff you can buy. If I ever have any left, I rarely do, I just buy a bunch of stuff that I can donate like period products and give them to local charities.
HSAs are health savings accounts. This is a similar idea, but unused money instead gets moved into a, you guess its, savings account where if you need to spend a larger amount of money at a single time you have access to it.
E: Oh yeah copays are a thing too, I don’t really have them so I forget about them. Co-pays are fees that are due at time of service (checking in for an appointment). They usually range from between $10~75, though that higher end seems a lot less common.
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