How coverage works
Plain explanations of the deductible, the out-of-pocket maximum, how a premium is set, and how the subsidy is settled at tax time. Written to be read before you compare plans, not after you have a bill.
How a health insurance deductible works
The amount you pay for covered care in a plan year before the plan starts paying its share. Some services are covered before you reach it.
4 minute read
What the out-of-pocket maximum protects you from
The ceiling on what you pay for covered in-network care in a plan year. After you hit it, the plan pays 100 percent of covered services.
How your monthly premium is set
Age, county, tobacco use and household composition set the price. Health history cannot. Your credit is applied before you pay.
5 minute read
Subsidy reconciliation at tax time
The credit you take each month is an advance on a tax credit. Form 8962 settles the difference between your estimate and your actual income.
These pages explain how coverage works in general terms. They are not a plan document. Benefits, networks and cost sharing are set by each carrier contract, and the plan documents control.