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Personal Consumer Issues • Copay only, $0 deductible, ACA plans - does it work for you?

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One downside of a copay plan I have seen, reading on Reddit, is that when you have hit your out-of-pocket max, the front desk will still ask you to pay a copay (because they are not privy to where you are relative to your OOP). Then you have to write a letter to the billing departments to get your co-pays reimbursed. That would be a pain in the butt

It would seem copay plans work for the average individual, and may actually save you money if your co-pays come out to being well under the out-of-pocket Max, but not for someone who has a lot of appointments with imaging (the latter having high copays)
Unlikely that you will hit your OOP max with just $40 or $60 copays.
Probably correct, although outliers occur. The year my second child was born, and contracted RSV which resulted in four hospital admissions, I had 50 office visits at $10 co-pays + I don't know how many prescriptions. The pharmacy staff sent me a photo Christmas card that year!

Statistics: Posted by HereToLearn — Sun Nov 02, 2025 9:41 pm — Replies 5 — Views 479



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