About Joanne Kenen
Contributing editor to Politico Magazine and former health care editor-at-large, Politico, Commonwealth Fund journalist in residence and assistant lecturer at Johns Hopkins Bloomberg School of Public Health.
One of the “simple” aspects of health insurance is – naturally – not always so simple.
There’s been a lot of talk about high deductibles in marketplace plans – higher than what most of us pay if we have insurance through a job. And since it’s often misrepresented or misunderstood by some of the people out there either praising or (more often) condemning the Affordable Care Act because of the deductibles, it’s important to understand them so you know what questions to ask.
The simple standard definition of a deductible – what you have to spend out of pocket before insurance kicks in – is sometimes too simple. In some health plans, yes, the deductible is indeed that clear cut. Insurance doesn’t pay a penny until you pay X dollars out of pocket. But many of us get those complicated EoBs (explanation of benefits) that allocate some of our own out-of-pocket payment toward a copay, some toward the deductible – and still cover the service before that deductible is fully met. There may also be tiers or different deductible requirements depending whether the care is in or out of network, or whether it’s primary versus specialist care.
So, here are a few other things to remember when you write about the new coverage options and what they are or are not costing people. (Caveat: Some of the information comes in this post comes from educational material from the Department of Health and Human Services.)
Contributing editor to Politico Magazine and former health care editor-at-large, Politico, Commonwealth Fund journalist in residence and assistant lecturer at Johns Hopkins Bloomberg School of Public Health.