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: Sat Sep 24, 2011 08:42 pm Post Subject:
Is this a test? If so, there is not enough information to answer.
Posted: Mon Sep 26, 2011 08:21 pm Post Subject: deductible
hw can deductible be used as a risk management tools.
Posted: Tue Sep 27, 2011 05:47 am Post Subject:
It may be one of the most important things you do.
You may consult your insurance agent or even a risk management consultant in determining optimal deductible levels.
The key of risk management is not to insure loses that you can predict and can afford to pay.
Your goal should be to strike a balance between premium savings as well as claims costs.
Posted: Tue Sep 27, 2011 05:52 pm Post Subject:
You would determine the highest amount of a claim you would be willing to pay with your own funds. Set the deductible at that amount, and your premium will be the lowest possible for that protection. You pay all claims up to that amount, the insurance company pays whatever exceeds that amount in one claim.
Posted: Mon Nov 07, 2011 05:00 am Post Subject:
It's a form a co-payment and responsible in an effort to have the patient 'see' some of the medical costs and not to overuse their insurance. If they charged them no form of co-payment, then their usage would go up, but if there's a co-pay and deductible, they will be at least a little more hesitant.
Posted: Thu Feb 02, 2012 07:47 pm Post Subject: coinsurance
what does 100%/60% for coinsurance mean? And also if a company says 100% Coinsurance is that I pay 100% or the Insurance company pays 100%?
Posted: Fri Mar 30, 2012 10:21 am Post Subject: lBgRlKaIPVNDuMkcj
It is mostly a poasenrl decision. I prefer a large company with a local office staffed by a professional agent who I can speak with face to face in case I have a claim or a question. I dislike playing phone tag with a mindless voice on the telephone or a computer robot. Often those e insurance quotes are low balled to get your business and then later the rates will be raised. You don't necessarily have to visit each agent. use the phone, get quotes, then choose the best one for you (not necessarily the cheapest quote)
Posted: Tue May 01, 2012 08:00 pm Post Subject: First office visit on my own insurance
Hello,
This may sound very silly, but I am a new student in the United States, and am on my own health insurance plan for the first time, so I am not clear on some concepts.
I have an office visit appointment tomorrow (the cost is $100). My insurance deductible is $350 and after that, my insurance covers 80% (with 20% co-pay). I tried speaking to an insurance representative, and am not quite clear on what all this means.
Does this mean that my $100 office visit will be subtracted from my deductible? Will I have to pay the insurance company the $350 before my plan can be activated?
I guess what I am trying to ask is:
What will my out of pocket expense be for my $100 office visit?
Thanks in advance for your help.
Posted: Wed May 02, 2012 12:16 pm Post Subject: insurance
I was wondering whether its coinsurance after deductible or is it the whole insurance claim..Say I have a deductible of 500$ 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: Wed May 02, 2012 12:47 pm Post Subject:
I have an office visit appointment tomorrow (the cost is $100).
You don't tell us whether your insurance coverage is an HMO or PPO or some other form of health insurance.
You mention a $350 deductible and then use an incorrect term to describe an 80/20 coverage arrangement (you call it "copayment", but 80/20 coverage is known as "coinsurance").
If you have a deductible, the policy may or may not treat copayments as a deductible expense (the $100 office visit fee may be the copayment amount, although that would be unusually high -- most copayments are somewhere between $20 and $40).
If you can tell us what type of health insurance you have, we can probably give you a better answer. If you prefer to keep that more confidential, send me an email by clicking the link below.
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