EXPERT ADVICE FOR BUSINESSES

Hello again, and welcome to our blog, where we aim to help you be a more informed consumer.

We will discuss other important terms you’ll see in your healthcare plan.

We’ll be discussing coinsurance today.

So, coinsurance is the percentage of a covered Health Care Service you pay – 20 percent, for example- after you’ve paid your deductible.

Let’s say your health care plan has an allowed amount of $100 for an office visit, and your coinsurance is 20 percent. You’ve already paid your deductible for the year so you would pay 20 percent of the $100 office visit or $20. The insurance company pays the rest.

If you haven’t met your deductible, you will pay the total allowed amount, the $100, which would go towards your deductible.

So, as an example of coinsurance with high medical costs, let’s say that the following amounts apply to your plan and that you need a lot of treatment for a severe condition; the allowable costs* are $1,200. The deductible, in this case, is $3,000, the coinsurance is 20%, and your out-of-pocket maximum is $6,850.

So, if your out-of-pocket cost reaches $6,800, you’d pay only that amount. The insurance company would spend all the rest of the covered services for the rest of the plan year. Yay!

Remember, plans with low monthly premiums generally have higher coinsurance, and plans with higher monthly premiums typically have lower coinsurance.

If you have any questions regarding your coverage, plan, and how it works, or a friend or family member needing help, remember we are here to serve you, so call us at 915-591-1957.

Remember that in Plans for Life, we help you plan so you can live fearlessly.

*Allowable costs, in this case, means the amount that the network and that physician or that the representatives of that physician have figured out is the reduced pricing. A function and feature of healthcare plans in today’s day and age are that they reduce expenses by negotiating rates. This is similar to when you buy stuff at Costco or Sam’s Club. You pay a reduced cost because you buy them both through a carrier.