My agent has mentioned about an 80/20 coinsurance while signing up. But while going through the agreement I've come across a term called co-pay. Do both these terms mean the same?
Total Comments: 8
Posted: Wed Feb 10, 2010 05:19 am Post Subject:
No, they don't mean the same. It's a fact that you'd need to accept both of these options while signing up for the policy. I guess Co-pay is a flat amount that you'd need to pay in the event you need to file a claim.
Posted: Wed Feb 10, 2010 05:33 am Post Subject:
Co-insurance is always a percentage, for example: "80/20 coinsurance" Plans will commonly have different coinsurance percentages based on many different factors.
Co-pays are flat dollar amounts and can (and will) vary by type of service received. Doctor office visit co-pays, ER co-pays and hospitalization co-pays are usually different.
Many plans have a combination of both coinsurance and co-pays. The best thing to do is review your policy documents or certificate of insurance.
InsTeacher 8)
Posted: Wed Feb 10, 2010 06:11 am Post Subject: Co-insurance and co-payment
Co-insurance and co-payment cannot be used interchangeably. Co-payment is usually found in managed care plans. It is the fixed dollar amount you pay for each visit to the doctor. But co-insurance is always expressed as a percentage.
Co-insurance is sharing the cost between the insurer and the insured. It is paid after the insured has paid off his annual deductible. As in your policy, the co-insurance is 80/20 which means that the insurance policy would pay 80% of the medical expenses and you would be responsible for paying the rest 20% after you have met your deductible.
Posted: Thu Feb 11, 2010 10:04 am Post Subject:
I'd be really interested to know the factors that help determine our coinsurance percentages.
Does a policy holder need to meet both copay and co-insurance in addition to his deductible? OR is it that he needs to bear either of the two?
Posted: Fri Feb 12, 2010 08:52 am Post Subject:
Does a policy holder need to meet both copay and co-insurance in addition to his deductible?
I don't think there has to be a condition like that always. He may or may not need to do it depending on his policy.
Posted: Fri Feb 12, 2010 10:01 pm Post Subject:
[quote]I'd be really interested to know the factors that help determine our coinsurance percentages.
For employer based coverage, the percentage is usually picked by your employer. Most are 80/20 (insurance pays 80% employee pays 20%), but I have seen different. One would assume that a 60/40 plan with all other things being equal would have cheaper premiums then a 80/20.
Does a policy holder need to meet both copay and co-insurance in addition to his deductible? OR is it that he needs to bear either of the two?
Like stated above, Copays are set dollar amounts for different services. Myself, I pay 30 bucks for all office visits, 50 for urgent care, 100 for ER and 250 for hospital care. Copays typically do not add up for your out of pocket expense. These are just set amounts that you have to pay before insurance pays.
Coinsurance is the percentage you pay (20% like the example provided). There is usually a yearly maximum out of pocket for coinsurance (like 2k, 5k...) then the policy will typically pay at 100%.
Deductibles are normally paid prior to any payment from the insurance company. So if you have a 250 deductible and then an 80/20 plan, and you have a 1,000 bill after discounts. You pay $400.00 ($250 deductible and 20% of $750 that is left or $150.) That $150 goes towards your yearly maximum.
Posted: Sat Feb 13, 2010 05:47 am Post Subject:
Thanks to all of you for your responses.
So, I'd assume that under all circumstances I've to meet the deductible first. After this, I'd need to meet the copay amount for that particular service which was rendered.
Posted: Mon Mar 01, 2010 06:23 pm Post Subject:
I would call your agent and have him explain how the plan works. Agents are supposed to be there to help answer all of your questions.
Posted: Wed Feb 10, 2010 05:19 am Post Subject:
No, they don't mean the same. It's a fact that you'd need to accept both of these options while signing up for the policy. I guess Co-pay is a flat amount that you'd need to pay in the event you need to file a claim.
Posted: Wed Feb 10, 2010 05:33 am Post Subject:
Co-insurance is always a percentage, for example: "80/20 coinsurance" Plans will commonly have different coinsurance percentages based on many different factors.
Co-pays are flat dollar amounts and can (and will) vary by type of service received. Doctor office visit co-pays, ER co-pays and hospitalization co-pays are usually different.
Many plans have a combination of both coinsurance and co-pays. The best thing to do is review your policy documents or certificate of insurance.
InsTeacher 8)
Posted: Wed Feb 10, 2010 06:11 am Post Subject: Co-insurance and co-payment
Co-insurance and co-payment cannot be used interchangeably. Co-payment is usually found in managed care plans. It is the fixed dollar amount you pay for each visit to the doctor. But co-insurance is always expressed as a percentage.
Co-insurance is sharing the cost between the insurer and the insured. It is paid after the insured has paid off his annual deductible. As in your policy, the co-insurance is 80/20 which means that the insurance policy would pay 80% of the medical expenses and you would be responsible for paying the rest 20% after you have met your deductible.
Posted: Thu Feb 11, 2010 10:04 am Post Subject:
I'd be really interested to know the factors that help determine our coinsurance percentages.
Does a policy holder need to meet both copay and co-insurance in addition to his deductible? OR is it that he needs to bear either of the two?
Posted: Fri Feb 12, 2010 08:52 am Post Subject:
Does a policy holder need to meet both copay and co-insurance in addition to his deductible?
I don't think there has to be a condition like that always. He may or may not need to do it depending on his policy.
Posted: Fri Feb 12, 2010 10:01 pm Post Subject:
[quote]I'd be really interested to know the factors that help determine our coinsurance percentages.
For employer based coverage, the percentage is usually picked by your employer. Most are 80/20 (insurance pays 80% employee pays 20%), but I have seen different. One would assume that a 60/40 plan with all other things being equal would have cheaper premiums then a 80/20.
Does a policy holder need to meet both copay and co-insurance in addition to his deductible? OR is it that he needs to bear either of the two?
Like stated above, Copays are set dollar amounts for different services. Myself, I pay 30 bucks for all office visits, 50 for urgent care, 100 for ER and 250 for hospital care. Copays typically do not add up for your out of pocket expense. These are just set amounts that you have to pay before insurance pays.
Coinsurance is the percentage you pay (20% like the example provided). There is usually a yearly maximum out of pocket for coinsurance (like 2k, 5k...) then the policy will typically pay at 100%.
Deductibles are normally paid prior to any payment from the insurance company. So if you have a 250 deductible and then an 80/20 plan, and you have a 1,000 bill after discounts. You pay $400.00 ($250 deductible and 20% of $750 that is left or $150.) That $150 goes towards your yearly maximum.
Posted: Sat Feb 13, 2010 05:47 am Post Subject:
Thanks to all of you for your responses.
So, I'd assume that under all circumstances I've to meet the deductible first. After this, I'd need to meet the copay amount for that particular service which was rendered.
Posted: Mon Mar 01, 2010 06:23 pm Post Subject:
I would call your agent and have him explain how the plan works. Agents are supposed to be there to help answer all of your questions.
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