A Healthcare Blog

How do families limit out-of-pocket Marketplace spending?

Written by Action Benefits | Feb 5, 2024 8:53:41 PM

$9,450 for an individual, $18,200 for families. In 2024, these are the highest allowable out-of-pocket maximums on healthcare.gov. On many Bronze plans, which tend to offer the most affordable premiums, these numbers also represent your deductible.

Most families of four don’t have the resources to spend $18k per year before health coverage kicks in. So, what tools do they have to limit their out-of-pocket spending? We’ve got a few in mind.

Look for plans with copays before the deductible

High deductibles might have you wondering how broken that bone really is, but it will always be in your carrier’s best interest to keep you healthy. This inspires many carriers to cover some services with a copay, or fixed dollar amount, before meeting your deductible. Most commonly, you’ll see visits to your primary care doctor, specialists, and urgent/emergent care covered this way. Some plans may cover less-expensive generic medications with a copay.

Since these services aren’t subject to the deductible, you’ll only pay the flat fee when you get care --- not the full amount of the service. That $50 copay can feel a lot better than a $400 cash price, so the savings are real and immediate.

HSAs may save the day

Many high deductible plans come paired with a Health Savings Account, or HSA. These tax-advantaged accounts allow you to sock away money to pay for certain health expenses – including visits to the doctor, dentist, or emergency room. Money in these accounts is portable and yours to keep: it can grow tax-free with investment and has no expiration date.

Savvy savers can turn these accounts into a rainy-day fund for expensive care – whether you need that care now or well into your Medicare years. Whenever you need it, this cushion can help soften the blow of an unexpected medical bill.

Spend a little on ancillary products to save a lot

A little extra protection can go a long way. For less than the cost of an ER copay, you can purchase other coverage to protect your finances. Accident policies, for example, can pay a fixed amount for a broken ankle at a soccer game, or if someone mistakenly believes that a falling knife has a handle. Critical illness policies can provide a lump-sum benefit to both reimburse your healthcare expenses and replace wages if a heart attack or stroke occurs.

39.5% of Americans will face a cancer diagnosis, but cancer policies can give you a resource boost. It could be the difference between ponying up $18k of your own money each year or having an ancillary carrier foot the bill.

Which option is the best fit for me?

Every situation is unique. On-hand resources will affect the decision, as will your risk tolerance. A licensed health insurance agent can help you weigh the options and work to find a solution that meets your needs. Talk to our team to schedule your no-cost, no-obligation consultation.