Understanding Health Insurance Deductibles, Coinsurance and Copays

Jan 11

Understanding Deductibles, Coinsurance and Copays

When you’re shopping for health insurance there are some common health insurance terms that you need to understand. Almost all PPO and HSA health insurance policies have deductibles, coinsurance and copays that apply.

A deductible is a set amount that you the policyholder are required to pay before the insurer pays for any healthcare bills, with the exception of some copays. For instance, you may have a healthcare plan with a $1,000 deductible. You would have to pay $1,000 dollars toward your medical bills before the insurer would begin to pay any of your healthcare bills.

After you have reached your deductible for the year, this is when coinsurance comes into play. Coinsurance is the amount that you must pay for medical bills after the deductible is met. Most plans have a coinsurance percentage and different percentages that apply to in-network and out-of-network providers. The insurer may pay 80 percent of the bill to in-network providers, and your coinsurance amount would be 20 percent. The amount the insurer would pay to out-of-network providers might be 60 percent, and your coinsurance amount would be 40 percent in this case.

Copays exist on some policies. These are set amounts for services. You may have a copay of $30 for each office visit. There may be set copays for certain procedures. These copays would be paid before you reach your deductible in most instances.
You would pay your copays, deductible, and coinsurance for medical care until your out of pocket maximum is met for the year. This out of pocket maximum is the limit of what you would have to pay for all your care for the year except the premium payment.

Health insurance can be confusing, and there are many different plans available. A Henderson, Nevada brokerage like Doroshow Insurance will be able to help you with all of your health insurance questions. Call Doroshow Insurance today for a consultation.


Urgent Care vs. ER: When Should You Look for Emergency Care

Aug 25

Urgent Care vs. Emergency Room

Unexpected medical emergencies are a nuisance and sometimes unavoidable. Appropriately assessing your health issue can help you choose the best place to seek professional care, potentially saving you time and money. Here are a few things to keep in mind when making the decision to visit urgent care or the emergency room.

Urgent Care

Urgent care is the best option if your regular physician is not available and you don’t believe it is a good idea to wait for the next available appointment. Urgent care facility wait time is often shorter, and could be less expensive.

Most retail health clinics and urgent care facilities can treat:

  • Low fever
  • Minor cuts
  • Minor flu or cold symptoms
  • Minor infections
  • Minor trauma (ex: broken finger)
  • Rashes
  • Small cuts
  • Sore throat
  • Sprains
  • Strains
  • Vomiting

Emergency Room

Emergency room visits should be reserved for medical issues requiring immediate professional care. Often the wait time at the E.R. is very long, as patients with more severe injuries or illnesses are treated first. The benefit of going to the E.R. instead of urgent care is that since you are at a hospital, the healthcare professionals are prepared for any medical issues that come their way. If you are experiencing a life-threatening medical emergency and there is no one around to take you to the hospital, call an ambulance immediately.

You should go to the emergency room for treatment of things like:

  • Chest pain
  • Deep wound or laceration requiring stitches
  • Difficulty breathing
  • High fever
  • Injury to the eyes or head
  • Major broken bones
  • Numbness on one side of your body
  • Persistent or heavy bleeding
  • Poisoning
  • Seizure
  • Severe burn
  • Severe heart palpitations
  • Sudden head pain
  • Sudden weakness or trouble walking
  • Vision loss or sudden change in vision