[CSactuary]

Under the ACA, in and out of network must have the same cost sharing for ER care. It’s the risk you run having such a high deductible plan. But I’m sure you’ve saved monthly by paying lower premiums for such a low coverage plan.

[red-indian]

You are responding to a post where he paid $7,900 for a $11,800 procedure.

Under ACA Bronze, the worst plan, his copay should have been 40%.

Is it your assertion that $7,900 is 40% of $11,800?

[CSactuary]

? When you pay a % of the allowed amount that’s called coinsurance (not a copay). This is paid after deductible in most cases. So he would owe up to his deductible ($7,900) before his coinsurance would kick in.

A minimum value ACA plan must have > 60% AV and cover the essential health benefits. The coinsurance % is irrelevant so long as it meets those requirements.