Looking at a quote for health insurance, I see the decutible in and out of pocket. How does the coinsurance percent and coinsurance limit work?
Total Comments: 14
Posted: Thu May 27, 2010 03:18 pm Post Subject:
It's a percentage of the actual bill for which you are responsible. Usually quoted like 80/20 where the insurance company will pay for 80% of the bill and you will pay for 20%.
Posted: Wed Jun 02, 2010 08:27 am Post Subject:
Coinsurance is a percentage sharing agreement, as BNTRS has described. 80/20 is hard to find, and expensive when you do. 70/30 is far more common, but in some PPOs it can be as low as 50/50 in "out of network" situations.
The other part of your question was not answered. The coinsurance limit (also known as a "stop loss") is the most you will be required to pay out-of-pocket. Policy language varies, so you have to read it to know exactly how it is defined. It typically does not include the deductible, normally a fixed amount of first-dollar expenses, but policy language may choose to include it.
Once you reach the stop loss, however it is described, remaining covered medical expenses for the year are normally paid 100% by the insurer.
One way to define stop loss is to say, "The stop loss limit is $7500. If you have a 30% coinsurance, your out of pocket would be $2250 (30% of $7500).
Another way to state it is, "the maximum you will be required to pay out of pocket in a calendar year is the stop loss limit of $7500," in which case your total medical bills for the year would have to exceed $25,000 ($7500 = 30% of $25,000).
And you have not asked about "copayments" (copays). These are the token fees ($10/$20/$30) you pay to a service provider (generally) at the time of service. Some policies include copays in calculating the deductible and/or stop loss, most exclude all copays from being applied to the deductible and/or stop loss.
Posted: Sun Jun 06, 2010 12:51 am Post Subject:
It works similar to auto insurance. If your deductible is $500 and you get in a auto accident then you would be responsible for the first $500 and the insurance company would pick up the rest.
Posted: Sun Jun 06, 2010 07:49 am Post Subject:
Gee, Dave, how can you equate deductibles to coinsurance? The two are entirely different concepts.
Deductibles are an insured's agreement to cover the first dollar of a claim (up to several thousand of them in some policies).
Coinsurance is the insurance company's agreement to share the balance of a claim with the insured. We don't see that in auto insurance at all.
For that reason, most of us would disagree with your example.
Although not exclusive to medical insurance, coinsurance is most commonly associated with it.
Posted: Tue Jun 08, 2010 12:20 pm Post Subject:
Please go through the discussion shared at the following thread -
http://www.ampminsure.org/health/coinsurance-deductible.html
Posted: Fri Jun 18, 2010 06:23 pm Post Subject: coinsurance
Having a health plan that requires you to pay a coinsurance, or percentage participation, rate means that you’ll essentially be splitting the cost of your healthcare with your insurance carrier.
For instance, if your health plan has an 80/20 co-insurance rate, (coinsurance rates of 70/30 90/10, and flat rates of $5.00 to $20.00 per doctor’s office visit are also common) your insurance plan pays for 80% of your eligible medical expenses and you’re responsible for the remaining 20%.
and flat rates of $5.00 to $20.00 per doctor’s office visit are also common)
This is the only error in Jack's post.
COINSURANCE is a question that involves %%%%%
COPAYMENT is a question that involves $$$$$
Please don't confuse the two! They are not the same, and the discussion of each is very different.
Copayments are most closely associated with HMOs, which rarely get into any discussion of coinsurance, and almost never have anything to say about deductibles.
PPOs are also associated with copayments, but typically also include a discussion of deductibles and coinsurance. Some PPO contracts allow aggregating copays into the deductible and/or stop loss, others do not. One needs to read their contract carefully in order to understand the process.
Comprehensive Major Medical insurance does not normally include copayments, but is concerned with a deductible followed by coinsurance up to the stop-loss limit (or "out-of-pocket" limit).
Posted: Thu Jul 01, 2010 03:53 pm Post Subject:
GOOD POST.
Posted: Sat Oct 23, 2010 02:28 pm Post Subject:
I am getting better at understanding deductibles and coinsurances.
Posted: Thu May 27, 2010 03:18 pm Post Subject:
It's a percentage of the actual bill for which you are responsible. Usually quoted like 80/20 where the insurance company will pay for 80% of the bill and you will pay for 20%.
Posted: Wed Jun 02, 2010 08:27 am Post Subject:
Coinsurance is a percentage sharing agreement, as BNTRS has described. 80/20 is hard to find, and expensive when you do. 70/30 is far more common, but in some PPOs it can be as low as 50/50 in "out of network" situations.
The other part of your question was not answered. The coinsurance limit (also known as a "stop loss") is the most you will be required to pay out-of-pocket. Policy language varies, so you have to read it to know exactly how it is defined. It typically does not include the deductible, normally a fixed amount of first-dollar expenses, but policy language may choose to include it.
Once you reach the stop loss, however it is described, remaining covered medical expenses for the year are normally paid 100% by the insurer.
One way to define stop loss is to say, "The stop loss limit is $7500. If you have a 30% coinsurance, your out of pocket would be $2250 (30% of $7500).
Another way to state it is, "the maximum you will be required to pay out of pocket in a calendar year is the stop loss limit of $7500," in which case your total medical bills for the year would have to exceed $25,000 ($7500 = 30% of $25,000).
And you have not asked about "copayments" (copays). These are the token fees ($10/$20/$30) you pay to a service provider (generally) at the time of service. Some policies include copays in calculating the deductible and/or stop loss, most exclude all copays from being applied to the deductible and/or stop loss.
Posted: Sun Jun 06, 2010 12:51 am Post Subject:
It works similar to auto insurance. If your deductible is $500 and you get in a auto accident then you would be responsible for the first $500 and the insurance company would pick up the rest.
Posted: Sun Jun 06, 2010 07:49 am Post Subject:
Gee, Dave, how can you equate deductibles to coinsurance? The two are entirely different concepts.
Deductibles are an insured's agreement to cover the first dollar of a claim (up to several thousand of them in some policies).
Coinsurance is the insurance company's agreement to share the balance of a claim with the insured. We don't see that in auto insurance at all.
For that reason, most of us would disagree with your example.
Although not exclusive to medical insurance, coinsurance is most commonly associated with it.
Posted: Tue Jun 08, 2010 12:20 pm Post Subject:
Please go through the discussion shared at the following thread -
http://www.ampminsure.org/health/coinsurance-deductible.html
Posted: Fri Jun 18, 2010 06:23 pm Post Subject: coinsurance
Having a health plan that requires you to pay a coinsurance, or percentage participation, rate means that you’ll essentially be splitting the cost of your healthcare with your insurance carrier.
For instance, if your health plan has an 80/20 co-insurance rate, (coinsurance rates of 70/30 90/10, and flat rates of $5.00 to $20.00 per doctor’s office visit are also common) your insurance plan pays for 80% of your eligible medical expenses and you’re responsible for the remaining 20%.
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Posted: Sat Jun 19, 2010 06:36 pm Post Subject:
and flat rates of $5.00 to $20.00 per doctor’s office visit are also common)
This is the only error in Jack's post.
COINSURANCE is a question that involves %%%%%
COPAYMENT is a question that involves $$$$$
Please don't confuse the two! They are not the same, and the discussion of each is very different.
Copayments are most closely associated with HMOs, which rarely get into any discussion of coinsurance, and almost never have anything to say about deductibles.
PPOs are also associated with copayments, but typically also include a discussion of deductibles and coinsurance. Some PPO contracts allow aggregating copays into the deductible and/or stop loss, others do not. One needs to read their contract carefully in order to understand the process.
Comprehensive Major Medical insurance does not normally include copayments, but is concerned with a deductible followed by coinsurance up to the stop-loss limit (or "out-of-pocket" limit).
Posted: Thu Jul 01, 2010 03:53 pm Post Subject:
GOOD POST.
Posted: Sat Oct 23, 2010 02:28 pm Post Subject:
I am getting better at understanding deductibles and coinsurances.
Posted: Sat Oct 23, 2010 11:16 pm Post Subject:
That's a good thing, Nicholas.
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