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View Diary: Healthcare Reform and the Economy (160 comments)

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  •  The cap means (0+ / 0-)

    That after you pay for your insurance, you can't be asked to pay more than (say) $5000 per individual in co-pays, co-insurance, blah blah blah.

    For example, most insurance goes something like this:

    $2000 deductible - before this is hit, you are responsible for all costs. Or all costs in certain categories, like the ER.

    THEN, above the deductible, there's a split. It could be 90%/10%, where the insurance pays 90% of all the next band of costs. It could also be 60%/40%. Imagine a $100k hospital bill. Yes you have insurance.... but you are so screwed, man, on the hook for a bit more than $40,000.

    Some policies have an out of pocket maximum. So if it's $10,000, you pay your deductible, $2,000, then $8,000 of the next $80,0000 in bills, and then after that the insurance picks up everything... until you hit your lifetime cap. Your lifetime cap could be as low as $1 million or as high as $10 million. A $1m cap is fairly easy to hit. After THAT cap, the insurance pays 0% and you're SOL.

    Fry, don't be a hero! It's not covered by our health plan!

    by elfling on Sat Jul 25, 2009 at 06:45:03 PM PDT

    [ Parent ]

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