Question: I’m little confused about deductible for Bronze Plan.I understand I have to pay $30 each for primary care visit when I choose gold plan. Covered CA website also states that gold plan primary care copay is not subject to deductible. Health insurance benefits chart posted on Covered CA website states that Bronze plan cares copay are subject to deductible. What does it mean? I though copay is cost for services to which deductible does not apply. For example, standard benefits says specialty care visit copay is $70 and deductible is $5,000. Hospital charge me $300 for specialty care visit. Do I have to pay $300 before deductible $5000 met? And then pay $70 for specialty care visit after deductible met? Or do I have to pay $70 regardless of deductible?
Answer: The Bronze plans copays are not subject to the deductible for up to 3 office visits, including pre-natal and post-natal visits, mental health and substance abuse visits, and urgent care visit. What that means to you is you pay only the copay. The emergency room and ambulance copays only come into play once the deductible has been met for a given calendar year. So if you have already spent $5,000 in covered medical expenses for the calendar year and you go to the emergency room, you will pay the $300 ER copay only. Now let’s say you’ve already met the out-of-pocket maximum, having spent $6,350 for the calendar year, you will pay nothing for emergency room services or any other covered expense.