Your copay for a primary care (doctor’s office) visit is $20.
You visit your doctor, and the amount is $125.
You pay the doctor the $20 copayment.
CareSource Just4Me is responsible for the remainder of the amount, $105.
To visit the emergency room (ER), a deductible does apply.
Your plan requires you to pay $300 for an ER visit after you’ve met your deductible.
Your annual deductible is $200, and your ER amount is $2,200.
This means you need to pay $200 to meet your deductible plus the $300 copay for the ER visit.
CareSource Just4Me is responsible for the remainder of the amount, $1,700.
At this point, you have met your annual deductible of $200 for the year.
This deductible applies to other services too. After you have met your annual deductible (in this example, $200), any service that has a deductible will only require you to pay the copay or coinsurance amount for the rest of the year.
Please note that not all out-of-pocket costs go toward meeting your deductible. Coinsurance, copays and premiums do not count toward your annual deductible.
As in the example above, the $20 copay for the doctor’s office visit did not go toward the $200 deductible amount.