California health insurance  -  California health coverage basics  -  Understand deductible and out of pocket max

How to Compare the Deductible and Out of Pocket Maximum When Quoting


When you first run your California health quote for individuals and families, it's easy to glaze over and just look for the highlights.


Of course, premium is high (if not highest) on this list.



People also tend to look focus on copays whether for office visits or RX coverage but in order to really make a good decision, we need to understand how the different carriers reflect the true out of pocket exposure for the really big bills.


Some of this information has been streamlined and standardized with the ACA law but it's still really confusing!


Let's take a look at the most critical example of this when it comes to the deductible and max out of pocket.


You can always run your copay and deductible comparison quote here:


how to quote Covered California plans

First, a quick review of both deductible and max out of pocket


The deductible is the amount you will pay for medical expenses (at the discounted PPO rate if in network and on a PPO or HSA plan) before the carrier starts to help.


After the deductible is met, you will then usually pay a percentage (say 40%) of remaining bills until you hit the maximum out of pocket or OOP (out of pocket max) which are two different ways of saying the same thing.


For most plans, the carrier will pay 100% of covered benefits, in-network once the OOP is met.


That makes the OOP a really important concept and number since health insurance is quickly becoming about protecting from really big medical expenses (also called catastrophic) as rates have spiraled (along with deductibles/OOP's) over the past decade.


So that's our quick intro.


Now let's look at how the carriers might reflect this information in their benefit summaries.


You can access the online application here:

How to apply for California obamacare

Deductible as part of Max out of Pocket


ACA UPDATE:  All Max out of Pockets now include the deductible for ACA compliant plans


Let's give an example to simplify all the jargon.


Let's say you have a $2500 deductible. After the deductible, you will pay a percentage (the coinsurance mentioned above) of 40% for another $4000. Your total out of pocket is really $6,500 if you get a $20K bill of covered medical expenses.


So how do we proceed?


Our quoting engine shows both deductible and OOP in the summary page which is important.


Some of the biggest (if not the biggest) health insurance websites on the web will only show you the deductible which is misleading.


There are plans that have deductibles of $2500 and OOP's of $7K.


If you only see the deductible, it looks priced really well unless you understand that the real OOP is $7500 (a big number).


You need to know both to make an informed decision.


In the end, you can always click on the plan name while running your California health insurance quote to get more detail and even access to brochure which will spell out whether the OOP includes the deductible.


Of course, you can always go through the plans with us and we'll quickly be able to size up the best value while taking into account this accounting trick of deductible/max benefits.


You can run your California Health Plan Quote here to view rates and plans side by side from the major carriers...Free.


Again, there is absolutely no cost to you for our services.  Call 800-320-6269 Today!

  Follow on social media

Covered Ca tax credit
Call 800-320-6269
Our Services are FREE to You!

Call to Enroll over the Phone in 15 Minutes

enroll in Covered Ca Exchange coverage

Call 800-320-6269

Anthem Blue Cross California
Blue Shield of California under Covered California
Kaiser of California
Molina health through Covered California
Sharp health plan in Covered California
and more
Thousands of Californians
Hundreds of California Companies
Thousands of Californians
Hundreds of California Companies

from SC

"My sincere thanks for making a miracle happen- 2014 health insurance !! Many thanks for your expertise and advice yesterday !!"

from SD

"Thanks again for your help - I had absolutely no idea how to get this done when I got up this morning. You've made it remarkably easier than I expected. I hope you're not stuck at the office all night..."

from KV

"Anyway, I hope you got some time off this past week! Thank you again for your help and efforts on my behalf! I was very lucky to find you."

from EK

"I thank you very much for the time that you have invested in handling everything

from SR

"I truly appreciate the quick response and will think of you in the future if I need to make any changes to my insurance plans."

from VH

"You are awesome... takes a huge worry off my back, thank you for your kind. thanks for your time and kindness. !!"

from SA

"Wow, I can't thank you guys enough for your help...I couldn't imagine trying to tackle this on my own!"

from LM

"You are my new best friend. A HUGE thank you again.

Find out what customers are saying about our services

20 years of experience in the California health insurance market has taught us one thing...Competent and experienced guidance is Invaluable

We can quickly (very important) size up your health insurance needs and clearly explain the options available to you. Our focus is finding the most coverage at the best cost to you.

We are licensed Covered Ca agents with in-depth knowledge of their plans, process, and tax credits.

Call will be Pleasantly Surprised.  800-320-6269

Request a 10 Minute Health Plan Check-up

We'll quickly see if you have the best priced plan available and if you qualify for a tax credit


Our Services are FREE to You is a Goodacre Insurance Services Website

This website is owned and operated by Goodacre Insurance Services, which is solely responsible for its content. This site is not maintained by or associated with Covered California, and Covered California bears no responsibility for its content. The email address and phone numbers that appear throughout the site belong to Goodacre Insurance Services, and cannot be used to contact Covered California.