Understanding key terms in insurance coverage
When both you and your health insurance company pay your medical expense, it is called cost sharing. Deductibles, coinsurance and co-pays are all examples. Understanding how they work will help you know when and how much you have to pay for care.
- Deductible: A deductible is the amount you pay for health care services before your health insurance begins to pay.
- Coinsurance: your share of the costs of a health care service. It is usually figured as a percentage of the amount we allow to be charged for services. You start paying coinsurance after you have paid your plan’s deductible.
- Co-pay: fixed amount you pay for a health care service, usually when you receive the service. The amount can vary by the type of service. You may also have a copay when you get a prescription filled.
What does this mean for me?
When choosing a plan, think about how much you use your insurance and how much protection you want against unpredictable expenses. Here are a few things to consider:
- Deductible: A plan with a high deductible will have cheaper monthly payments. But you’ll pay a lot upfront when you need care. You can also look for plans that cover some services before you pay your deductible.
- Coinsurance: Typically, the lower a plan’s monthly payment, the more you’ll pay in coinsurance.
- Co-pay: If you visit your doctor or pharmacy often, you might want to choose a plan that has a low copay for office visits and prescriptions.
How do out-of-pocket maximums work?
An out-of-pocket maximum is the most you’ll have to pay during a policy period (usually a year) for health care services. Once you’ve reached your out-of-pocket maximum, your plan begins to pay 100 percent of the allowed amount for covered services.
In our office, we offer very competitive packages from famous carriers such as Kaiser, Blue Shield, Blue Cross CA, Anthem.