Understanding Health Insurance Deductibles, Coinsurance and Copays

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.


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