01
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.
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How coverage works
The four numbers that decide what a plan costs you
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.
02
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.
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03
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.
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04
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.
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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.