Kokomo Tribune; Kokomo, Indiana

Local News

November 8, 2013

Defining health care costs

Premiums, deductibles and out of pocket all consumer paid.

[Editor’s note: With significant portions of the Affordable Care Act to be implemented starting on Jan. 1, 2014, the Kokomo Tribune is running a series that explores how the personal responsibility mandate, the expansion of Medicaid and the new health exchanges will affect consumers.]

Q: What is the difference between a premium, deductible, co-pay and out-of-pocket maximum? If I pay premiums, a deductible and copays for the year, do those all apply to the out-of-pocket maximum? What happens when that amount is reached?

A: All of this terminology has been part of health insurance coverage for many years and details the amount a person pays for health insurance.

“The premium is the annual cost of health care insurance,” said Craig Dunn, a financial planner for Liberty Financial.

Premiums may be either deducted from a person’s paycheck or mailed on a monthly basis to an insurance company.

“The deductible is what you must pay each year before your insurance pays anything,” Dunn said. “The co-pay is the cost of medical services that you must share with the insurance company until your maximum out-of-pocket costs have been met.”

The out-of-pocket maximum is the limit established that includes all cost-sharing items, meaning deductibles, co-insurance and co-payments, Jennifer Lyons, a financial planner with Bucheri McCarty & Metz LLP, said.

“Premiums are not included in the out-of-pocket maximum,” she said. “Once the out-of-pocket maximum is reached, insurance will cover all additional qualified medical expenses.”

The monthly premium is directly related to the deductible, co-pay and out-of-pocket expenditures. Generally, the lower the monthly premium, the higher the other consumer costs and vice versa. The Affordable Care Act limits out-of-pocket maximums to $6,350 for an individual and $12,700 for a family plan. Those limits do not apply to grandfathered plans.

Readers can submit their questions on the Affordable Care Act to Enterprise Editor Ken de la Bastide at ken.delabastide@kokomotribune.com or by mailing them to Kokomo Tribune, care of Ken de la Bastide, 300 North Union St., Kokomo, IN, 46901.

1
Text Only | Photo Reprints
Local News
  • Waterford Place looks to 11 senior living duplexes to campus More senior living options could be on the way in Kokomo.Waterford Place Health Campus, located in the 800 block of St. Joseph Drive, is looking to expand with 11 new senior duplexes after receiving approval from the Kokomo Plan Commission’s plat com

    August 1, 2014

  • Trial dates moved in Wagoner clinic drug case Trial dates for seven of the eight people charged in the Wagoner Clinic prescription drug case have been moved to Oct. 3.Several of the suspects – including Marilyn Wagoner, the wife of Donald Wagoner, the former head of the clinics – were set to sta

    August 1, 2014

  • NWS - Summer Fest 02 Russiaville Summer Fest starts Friday RUSSIAVILLE — You think you can knock a baseball out of the park? There's a contest for that. If you love to sing, there's an activity for that. If you're afraid to sing but know the words to your favorite song, there's an activity for that, too. The

    July 31, 2014 2 Photos

  • July 2014 has been the coldest on record Veteran Indiana residents are familiar with the old adage as it pertains to weather: "Hang out, it's sure to change." And, change it has. Just 24 months removed from the hottest July on record in 2012, the National Weather Service announced late Thur

    July 31, 2014

  • One injured in motorcycle crash A 50-year-old man suffered chest injuries when he crashed his motorcycle at Washington and Lafountain streets Wednesday afternoon. A Kokomo Police Department accident report stated Tommie Barger of Kokomo was driving a 1983 Honda 1100 south on Lafoun

    July 31, 2014

  • BMV offering driver tests in 11 languages INDIANAPOLIS (AP) — The Indiana Bureau of Motor Vehicles is now offering drivers tests in 11 languages other than English that are spoken across Indiana. BMV Commissioner Don Snemis said Wednesday the decision was made at the urging of businesses, un

    July 31, 2014

  • Tionna Brown 02 Kokomo celebrates Tionna Brown's gold medal victories Little boys with pretend gold medals around their necks fought Wednesday to get their pictures taken with a pint-sized superstar who had won three real gold medals for herself. Twelve-year-old Tionna Brown just returned from Texas after competing in

    July 31, 2014 2 Photos

  • KFD Rescue 2 Staffing changes leave Kokomo Fire Department with one rescue truck

    A shift in how the Kokomo Fire Department is staffed and responds to calls has some firefighters worried they will not have access to all the equipment they need. City officials, however, maintain there will be no change in the quality of service pro

    July 30, 2014 2 Photos

  • Kokomo Police officers reach out to public Tuesday Kokomo police will be out in full force Tuesday in area neighborhoods. In addition to their regular patrols, officers will be out getting to know residents and the issues they may have as part of National Night Out, a crime prevention event. National

    July 30, 2014

  • Feds cite Indiana Medicaid fraud unit over notices INDIANAPOLIS (AP) — A federal agency found that the Indiana attorney general's office didn't give proper notice in nearly a quarter of the Medicaid fraud cases it helped prosecute in recent years. A report from the Department of Health and Human Serv

    July 30, 2014

Latest news
Featured Ads
Only on our website
AP Video
Netanyahu Vows to Destroy Hamas Tunnels Obama Slams Republicans Over Lawsuit House Leaders Trade Blame for Inaction Malaysian PM: Stop Fighting in Ukraine Cantor Warns of Instability, Terror in Farewell Ravens' Ray Rice: 'I Made a Huge Mistake' Florida Panther Rebound Upsets Ranchers Small Plane Crash in San Diego Parking Lot Busy Franco's Not Afraid of Overexposure Fighting Blocks Access to Ukraine Crash Site Dangerous Bacteria Kills One in Florida Workers Dig for Survivors After India Landslide Texas Scientists Study Ebola Virus Smartphone Powered Paper Plane Debuts at Airshow Southern Accent Reduction Class Cancelled in TN
Parade
Magazine

Click HERE to read all your Parade favorites including Hollywood Wire, Celebrity interviews and photo galleries, Food recipes and cooking tips, Games and lots more.
Obituaries