Copay and Deductible and Coinsurance plans

Copay and Deductible and Coinsurance plans

How do out-of-pocket costs work?

 copayment  (or copayment) is the flat fee you pay each time you see your doctor or fill a prescription. For example, if you have the flu and go to see your doctor, or need to get a refill on your diabetes medicine, the amount you pay for that visit or medicine is your copayment.

 deductible amount that you pay each year for most eligible medical services or drugs before your health plan begins to share the cost of covered services. For example, if your annual deductible is $ 4,000, you will have to pay the first $ 4,000 of your total eligible medical costs before your plan begins to share costs.

Coinsurance

Coinsurance is the portion of medical costs you pay after your deductible has been met. Coinsurance is a way of saying that you and your insurance plan pay a portion of eligible costs that add up to 100 percent.

For example, if your coinsurance is 30 percent, you pay 30 percent of the cost of your covered medical bills. Your health plan pays the remaining 70 percent. If you meet your annual deductible in May and need an EKG in July, you are covered by coinsurance.

When you go to the doctor, after the consultation, you can have a prescription with the necessary medications to regain your health or you can receive indications for tests or procedures that help the doctor make a more accurate diagnosis.

When you pay for medicines or the indicated tests or procedures, you have to assume a part of the total payment, that is the coinsurance.

This coinsurance can be covered in different percentages, from 0% with which you would have to assume the entire cost; up to 100%, with which you would not have to make any payment since the insurance would cover everything.

What are the out-of-pocket maximums?

Any money you spend on deductibles, copays, and coinsurance counts toward your out-of-pocket maximum. Once you reach your out-of-pocket maximum, your health insurance plan covers 100% of all covered services for the rest of the year. However, premiums don’t count, and neither does anything you spend on services your plan doesn’t cover.

For example:

If your back hurts a lot and the internist refers you to the neurosurgeon, and he in turn orders an MRI, this exam would have to be paid for with a coinsurance.

If the exam costs S / 1000, if for example you have Multisalud insurance and it provides you with 90% coverage, it means that you would have to pay only S / 100, and the other S / 900 are assumed by your health insurance.

If you go for cough and the internist gives you a prescription, you can buy the medicines with 90% coverage at the pharmacy of your choice.

If you’re a healthy and careful person, a low-cost plan with higher limits maybe your best option. However, if you expect to have significant health care expenses, it may be worth spending more on premiums each month to get a plan that covers more of your costs.

Conclusion

When you buy a health insurance plan, the policy always spells out the premiums (the amount you pay each month to have the plan), deductibles, copays, coinsurance, and out-of-pocket limits. In general, premiums are higher for plans that offer more favorable cost-sharing benefits.

If you’re a healthy and careful person, a low-cost plan with higher limits maybe your best option. However, if you expect to have significant health care expenses, it may be worth spending more on premiums each month to get a plan that covers more of your costs.

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By Daniel Lincoln

Daniel Lincoln is the founding member and Manager of Multiple Websites for First SEO Paper, also the owner of high-level quality sites focusing on General Categories only.

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