January 2019: THAe: Deductibles and OOP Max

Deductible and Out of Pocket Maximum. What do those even mean?

The deductible is the amount you have to pay before the plan will start sharing costs for services with you.  Because you enrolled in this high-deductible plan, you will pay $3,000 for all care and prescriptions and then the plan will start sharing costs with you. The out of pocket maximum is the most you’ll have to pay in a year. Call Texas Health Aetna before you receive care to be sure you know what costs you’ll be responsible for and how the insurance will cover your care.

Until you pay the full $3000 deductible for:

  • health care services (doctor’s office visits, urgent care visits, ER visits, etc.)
  • prescription drugs (medications you take on a regular basis, etc.)

you pay 100% of the cost for those. The plan will not begin to share costs of health care services or prescription drugs until the deductible has been met.

Once you meet the $3000 deductible, you’ll pay:

  • Medical: 10% of the cost of services, and the plan will pay 90%. A full list of your costs for services is located here.
  • Prescriptions: this depends on which RX plan you chose. Check out the details on costs here.