Every health plan comes down to five numbers. Most people can recite them and still cannot say what a visit will cost. Below is one plan and ten situations. Work out what you would pay, then tap Next. The plan card stays on every page. All prices are the plan’s in-network allowed amounts.
Situation 1 · January
You have a sore throat and see your primary care doctor. The visit is priced at $150. Your plan lists primary care as “$30 copay, deductible does not apply.”
What do you pay?
Correct!
Not quite.
The copay is the number that matters here. “Deductible does not apply” means the plan pays its share from the first visit, and you pay the flat $30. Many plans treat primary care, urgent care and generic drugs this way. Others apply the deductible first, in which case this visit would have cost the full $150. That one phrase in the plan summary is worth looking for.