Typically an insurance policy will have a deductible, a coinsurance or copayment, and an out of pocket maximum. Although every insurance plan is different and may not have each of these, it’s important to understand them and how they work. It’s especially useful when it comes time to choose future health care plans.
Coinsurance
A coinsurance is a percentage of the costs for health care services you are responsible for paying after you’ve met your deductible.
- For example, if the health insurance plan’s allowed amount for an office visit is $100, and Dwayne has met his deductible already, his 20% coinsurance payment would end up being $20 (20% of $100).
- The health insurance company will then pay the rest of the allowed amount ($80).
Coinsurance amounts can be different depending on the type of service. You may have a 10% coinsurance for chiropractic visits yet have a 20% coinsurance for exam visits. Some services may not require a coinsurance at all.
Although it may seem complex, understanding health insurance will be helpful. You may even start noticing how some ads can be misleading. Especially to those who aren’t as familiar with health insurance.
Popular insurance commercials often claim that their plans “have no copays, no coinsurances” or things along that same line. These plans may sound appealing, but the money being “saved” has to be balanced out somewhere. Whether it’s by charging you high monthly premium payments or limiting the doctors and services that are covered.
A good rule of thumb is if it seems too good to be true, it probably is. Look further into the eligibility and benefits of the plan to see just how “perfect” the plan really is.
Using your newly found knowledge about health insurance plans will allow you to better decide whether those plans are right for you and your family.
For more information regarding insurance benefits, click here.
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