Coinsurance "-a percentage of a bill for a service that someone pays out of pocket.
How do these elements vary from
policy to policy?
The tradeoffs
Risk versus coverage "-Buying insurance means weighing risk against the price of protecting yourself from that risk. In health insurance, it means considering your health, trying to predict what sort of medical problems may surface, and figuring out how much you can afford to cover those risks. In general, the higher the premium, the more comprehensive the coverage. Policies with lower premiums tend to carry more financial risk if you get sick.
Premiums versus coinsurance, copays, and deductibles Low premiums may also mean high coinsurance, copays, and deductibles. People may choose low premiums and hope that they won't use many services during the year.
Will shoppers in the exchanges flock
to low-premium plans, leaving themselves exposed to risk if they get sick?
The essential benefits
Under Obamacare, all policies sold in the individual market must cover 10 essential benefits: doctor visits and outpatient services; emergency care; hospital care; maternity and newborn care; mental health and substance-abuse disorders; prescription drugs; rehabilitative services and devices; lab tests; preventive services and chronic-disease management; and pediatric care.
What services patients actually get among these 10 will vary from policy to policy. An insurer can comply with the law while limiting the number of visits for physical therapy, say, or for some other services. Or an insurer can require policyholders to pay more out-of-pocket for particular services, or vary the deductible.
However, Obamacare limits what people will pay out of pocket to $6,250 this year for individuals and $12,500 for families (including deductibles).
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