by renditioner » Wed Aug 27, 2008 09:12 am
A lot of you may be confused with what is coinsurance after deductibles. It is true that many individuals purchase health insurance without knowing that co-payment and deductibles are two different things. If you are purchasing health insurance you must be aware of what the policy holds for you and clearly you must be aware of the different terms used and what they mean.
What is a deductible and co-insurance?
Deductible: This is the amount that you are responsible to pay before your insurance company starts paying when a claim is made. Your premium value is also determined by the deductible that you choose. The higher the deductible, the lower will be your premium.
Co-insurance: Say you have a deductible of 2000 and the hospital bill comes around at 20, 000. As a rule you have to pay off the deductible, i.e. 2000 out-of-pocket before the health insurance company begins to pay. So you still need 18000 to pay off the rest of the bill. If you have a 80/20 co insurance and the insurance company pays 80%, you need to make 20% of the remaining 18, 000. This means that your out-of-pocket costs would be deductible + the percentage of co-insurance you have agreed upon.
Co-insurance also has a stop loss clause that lets you pay your share of the co-insurance up to a certain limit for that year after which the insurance company bears 100% of the claim amount.
The difference between coinsurance and deductible is not clear to a lot of individuals. This may create a lot of confusion when you make a claim. But if your policy has this clause you must clearly understand what will be your contribution after a claim is made. Ask your agent to explain what portion you will have to pay and what portion your insurer would pay and how both co insurance and deductible would come into play.
Co-insurance: Say you have a deductible of 2000 and the hospital bill comes around at 20, 000. As a rule you have to pay off the deductible, i.e. 2000 out-of-pocket before the health insurance company begins to pay. So you still need 18000 to pay off the rest of the bill. If you have a 80/20 co insurance and the insurance company pays 80%, you need to make 20% of the remaining 18, 000. This means that your out-of-pocket costs would be deductible + the percentage of co-insurance you have agreed upon.
Co-insurance also has a stop loss clause that lets you pay your share of the co-insurance up to a certain limit for that year after which the insurance company bears 100% of the claim amount.
The difference between coinsurance and deductible is not clear to a lot of individuals. This may create a lot of confusion when you make a claim. But if your policy has this clause you must clearly understand what will be your contribution after a claim is made. Ask your agent to explain what portion you will have to pay and what portion your insurer would pay and how both co insurance and deductible would come into play.
What does coinsurance after deductible mean?
Coinsurance after deductible means that under a health insurance policy the insured will cover a fixed percentage of the covered expenditures after the deductible has been paid. This is almost similar to co-pay except that in co-pay the insured is supposed to pay a fixed dollar amount instead of a percentage when the medical service is delivered.
Related Readings:
- Difference between co-pay and co-insurance
- What is co-insurance stop-loss?
- About co-insurance
- Co-insurance explained
I was wondering whether its coinsurance after deductible or is it the whole insurance claim..Say I have a deductible of 500$ and a 70/30 coinsurance policy .When does the coinsurance come into play?After I pay the 500$ deductible or for the whole sum of the insurance claim?
Posted: Tue Jan 11, 2011 06:08 pm Post Subject: Full Roof Replacement
Company has asked for payment of deductible even before roofing has begun (which will not be until spring due to wether conditions). Why???
Posted: Wed Jan 12, 2011 02:48 am Post Subject:
If the contractor is doing the job for the full value of the insurance company's estimate, then you owe the deductible. When it gets paid is between you and the contractor. Consider it a deposit on the contract. No deposit, no contract -- prices could change. Then where will you be?
Posted: Wed Apr 06, 2011 12:35 pm Post Subject: medicare
i have part a and b and no other ins. i am 75 yr old if my bill is 500.00 how much will i have to pay? will it be less when i meet my deductible?
Posted: Wed Apr 06, 2011 03:18 pm Post Subject:
You must be talking about Medicare Parts A&B. Part A primarily covers in-patient hospitalization (no doctor's bills). Part B primarily covers physician's and surgeon's and outpatient hospital expenses.
If you are hospitalized in 2011, there is a deductible of $1132 per benefit period (day of admission to 60th day after discharge from hospital), and medically-necessary services are generally covered 100% during the first 60 days of hospitalization.
If you see a doctor (in or out of the hospital), under Part B, there is a one-time deductible per calendar year ($162 in 2011) that is payable before Part B benefits begin. Once the deductible is satisfied, most Part B medically-necessary services are covered on an 80% (Medicare) / 20% (Medicare beneficiary) basis when using a "Medicare-approved" physician/surgeon (with additional limitations on billable amounts imposed by Medicare). You will pay a higher percentage of the bill from a non-approved physician/surgeon. You cannot be billed for any amount that exceeds Medicare's "approved amount" for any service (except that a non-approved provider may bill up to 115% of the approved amount, but Medicare only pays 80% of 90% of that amount -- very confusing, right?).
If you were not hospitalized, but simply saw a physician or went to the emergency room at a local hospital, and you have not had any other medical appointments in 2011, then you will be responsible for the $162 deductible, and about $68 (20% of the $338 difference), or total out of pocket expense of about $230. Future similar bills will be paid on the 80/20 coinsurance basis.
You might be able to significantly reduce your out of pocket expenses by enrolling in a Medicare Advantage plan in 2012 (open enrollment begins in November). You may be eligible to enroll in a Medicare Advantage plan (now until May 15), in which case your coverage under that plan would begin on July 1. It will not cover expense incurred prior to July 1. Talk to a local insurance agent about the available plans in your area.
Posted: Fri Apr 29, 2011 03:19 pm Post Subject: deductible and coinsurance
I have 600 deductible, 80/20 coinsurance. Before surgery, I paid 350 to Doctor and 600 to hospital. After the surgery I paid 100 for tomography. I have 444 dollar pathology bill from hospital and my insurance says I had to pay all money because deductible...Didn't I paid deductible yet....Help please...
Posted: Fri Apr 29, 2011 03:19 pm Post Subject: deductible and coinsurance
I have 600 deductible, 80/20 coinsurance. Before surgery, I paid 350 to Doctor and 600 to hospital. After the surgery I paid 100 for tomography. I have 444 dollar pathology bill from hospital and my insurance says I had to pay all money because deductible...Didn't I paid deductible yet....Help please...
Posted: Fri Apr 29, 2011 07:44 pm Post Subject:
Melinda . . .
Your insurance company may not be aware of the payments you have made to the hospital or doctors. Have you supplied them with the information they need to see that you have already paid the deductible? Additionally, are you certain that the expenses you paid for are all covered expenses?
Although I don't know the sequence of events or timing of payments, or even what's actually covered, based on what you state, it does appear that you may have satisfied the deductible. Present all the bills you have that are marked "PAID" to your insurance company and see what they say.
Posted: Wed Aug 31, 2011 05:59 pm Post Subject: primary ins and seconddary
I have an account total of 196.00 the primary ins paid 158.27 with adj of 9.80 leaving 27.93 in coinsurance so secondary ins acknowledges primary ins but only puts in a adjustment of 3.92 no payment but under deductibe on secondary it has 192.08. Do we have to acknowledge the secondary adjustment because secondary ins ded is greater than the primary ins coinsurane of 27.93
Posted: Wed Aug 31, 2011 06:49 pm Post Subject:
No clue as to what you are talking about.
Posted: Sat Sep 24, 2011 04:48 pm Post Subject:
A patient is a member of a health plan with a 15% discount from the provider's usual fees and a $10.00 copay. The days' charges are $480.00 What are the amounts the plan and the patient each pay
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