Suppose someone purchases a shiny new high deductible plan as offered through the ACA individual marketplace. They go to a doctor to get a chronic problem fixed. The cost of treatment is less than the deductible (which can be $6000).
As an example, suppose they are getting a mole removed. The ‘book rate’ for the procedure is $1000. Now that they have insurance, will they have to pay $1000 out of pocket (since it is under the deductible) or will they at least get to pay the insurance rate (which might be $300 or less)?
Every insurance plan I’ve ever had, whether Obamacare compliant, employer-supplied or purchased individually, any charge before I met my deductible was billed at the insurance company’s negotiated rate.
Yes, Obamacare isn’t a fundamental change in how works, rather a requirement to have it and the requirement to cover certain services, with limits on deductibles, doing away with pre-exist, etc. So provided it’s a participating provider the plans work like any other policy where you owe up to the insurance allowed amount if they pull it all to deductible.
Of course if the provider is nonpar, you would probably be responsible for the whole charge, but that is nothing new either. I’ve seen people wind up owing $50,000 because they chose to get routine surgeries done at a nonpar provider, whereas they would have owed nothing or at most a couple of thousand at a par provider.