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California health insurance  -  Understand health insurance in California  -  Two member max

The Two Member Max and California Health Plans

A concept that is new to most people purchasing health insurance is the two member max. You will typically see this next to a deductible or max out of pocket amount with a (x2) designation. This is an important part of the plan in terms of keeping a family out of catastrophic health cost situations.

So how does the Two member max work?

First, it really only applies when you have multiple people (three or more) on one health insurance policy in California. A single person or two people together will not be affected by the two member max.
Essentially, for three or more people on one policy, each person is working towards their annual deductible. If two people meet their deductible, the other family members will not need to. The deductible is the amount you must pay for medical services each year before your insurance begins paying. You can find more in-depth information on deductibles in California health plans here. It is like a horserace where each person is accumulating costs towards their deductible. The first two across the finish line let the other family members stop (working towards their own deductible). With most health plans on the market, the annual deductible (calendar year Jan 1st resets) is per person. With the two member max, it protects a family from having to meet four deductibles (for example) if four family members all had significant medical bills during the same year.

What does the max apply to?

The two member max usually applies to the annual max out of pocket as well. The out-of-pocket max is the most you will have to pay in a year for deductibles and coinsurance for covered benefits. You can find more in-depth information on the max-out-of-pocket. This is important for the same reason the cap on deductibles is important. In today's world, with the high cost of medical care and the higher deductible amounts, if you are meeting your deductible, you are probably meeting your max out of pocket as well. A simple surgery can quickly run $20,000.

There are some exception on the California health market for the two member max. You will not see the (x2) designation next to these plans. Some plans also now have a 1 max + rest of family situation. This means when one person meets their out of pocket max, the rest of the family members all work together to make up the remaining deductible. This is actually a better set-up for the California consumer.


Important Plan Pieces:

max out of pocket
Catastrophic health insurance

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