This might be a stupid question, since I don't know how the US system works - if you have health insurance, why do you have to pay anything for drugs "covered" by your insurer? If they cover a medication, why is there anything left to be paid by you? Do you also have to pay if you have any treatment that is "covered" by your insurer?
As an example, I have a 4500 dollar deductible. That means until I pay 4500 for prescriptions, doctor visits, labs, ER visits, etc., insurance pays nothing, though I do get their negotiated "discount" from the provider. After that, the insurance pays 80% of the cost until I have paid out some even larger number, at which time they pay 100% until January rolls around.
This is a pretty normal plan, and the type the guy you're responding to is describing; older plans often have much lower deductibles and have copays, though premiums tend to be higher, but one they're hard to find now.
It's very easy to meet a 4500 deductible. I've already done it for the year without any major health events.
Switzerland has the same system with deductibles and after that you need to pay 10% with a maximum of 700 per year.
Cost is about 220 per month for a insurance with 2500 (max allowed) deductible and 320 per month for the one with 300 (lowest allowed) deductible.
I mean, the reason I asked is that I can't imagine paying anything for any treatment or medication. The thought that you pay for private health insurance and yet have to pay anything for medicine/treatment is super weird to me.
It's not arbitrary, the deductibles and copays push down the monthly premiums.
Under the ACA, the cost sharing is standardized, so it isn't simply a matter of the insurance company enriching itself or anything like that. This document discusses how the standardization works: https://kaiserfamilyfoundation.files.wordpress.com/2013/01/8...
The idea is because you have to pay a little bit out of your own pocket you are less likely to run to the doctors and get a prescription when nothing is wrong. Since it is your money that you could spend on something fun instead of a pill you will ask do you really need to buy the pill, or will a cheaper pill work just as well. Note that the above is the idea - there are various problems with it, but the idea makes some sense.
There is a real problem with some people going to the doctors and demanding a pill to fix some problem, doctors get tired of seeing this person and prescribe something relatively harmless just to get them to go away.
Doctors used to prescribe antibiotics for viral illness as well because people expected a pill from the doctor.
Some old people have no friends left so talking to the doctor is the only social life they have.
Do not confuse the above with with cases where there is something wrong and the doctor cannot figure out what.
The co-pays for some drugs can get pretty steep for people on fixed incomes like social security. If the only reason is to keep people from nagging the doctor, you'd think that the co-pays would be fixed instead of varying wildly depending on the drug.
Health insurance plans have varying coverage for drugs (and those plans can vary a lot state to state), so that's going to depend on the plan. Decent plans typically pay everything but a very small charge. Average plans often have limits to routine prescription drug coverage in a given year.
A medication I took last year cost around $90-$100 or so. The insurance covered all but $10 of that.
