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View Diary: ACA, Understanding the details: Actuarial values of the plans' tiers & why you can ignore them (154 comments)

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  •  It helps, but it is very odd. (0+ / 0-)

    It means that if I satisfy the OON deductible (which my daughter will do around the middle of the year), there is an incentive to look for out-of-network providers for other services, which seems to be an unintended consequence.  So she sees a doctor once a week who is OON.  After July or so, she will have used up the OON deductible, so further visits to that doctor will be paid.  If she needs to go to a different doctor, we actually will prefer to find an OON doctor, so that that will be covered rather than applying toward the in-network deuctible.

    That's weird.  It means that because her regular doctor visits are OON, we should prefer all her other doctors should be OON too.  An incentive to go out of network for doctors.

    •  No one said this is rational! (0+ / 0-)

      It's insurance.

      You will still have a co-pay I presume, and the co-pay is usually higher for OON. So that is the motivator for in-network.

      •  Even though the co-pay is higher for OON, (0+ / 0-)

        if the OON deductible has been satisfied and the in-network deductible has not yet been satisfied, I get zero for seeing the in-network doctor, while I get something (in this case 70%) for seeing the out-of-network doctor.  Co-pays only apply once the deductible is satisfied.  In this case, the year is likely to be up before the in-network deductible is satisfied.

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