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8 years ago · by · 1 comment

Health Insurance Coinsurance 3 Things You Must Know Before You Buy

In addition to sharing with you a health insurance coinsurance definition, I want to share with you 3 important things that you may not know about coinsurance. When it is time to buy a health insurance policy, an investment in information can reduce your investment in dollars. Not understanding how coinsurance works can cause you to under estimate or over estimate the value of a policy and buy the wrong health insurance policy.

Health Insurance Coinsurance Definition

What is coinsurance for health insurance? Coinsurance is one of the three major cost shares you can expect to find in most health insurance policies. The other two are deductible and copay.

Coinsurance is not found on every policy, however, on many policies you are expected to pay a certain percentage of your medical expenses. This percentage is called coinsurance.

There are three things that you may not know about coinsurance even if you are aware of the standard definition. Not having this information can cause you to buy a policy that is not as good as you think it is. It can also cause you not to buy a policy that is better than you think it is.

  • Coinsurance Percentages Are Not Standard
  • Out-Of-Network Coinsurance Is Usually Higher
  • Out-Of-Pocket Maximum Limits Your Exposure

Coinsurance Percentages Are Not Standard

Although coinsurance has traditionally been 20 percent for the consumer, this is not the case with all policies. Some policies limit the consumer’s coinsurance costs to 10 percent. Other policies may require the policyholder to pay 50 per cent in coinsurance.

Out-Of-Network Coinsurance Is Usually Higher

Out-of-network coinsurance on a health insurance policy is usually much higher than in-network coinsurance. It usually pays to go to in-network doctors, hospitals and other health care providers.

(In addition to paying a higher coinsurance percentage when you seek care from out-of-network providers your other cost shares may be higher; your benefits may be lower as well. Your deductible may be higher. Your co-pays may be higher. Your out-of-pocket maximum may be higher. Your annual or lifetime benefit limit may be lower.)

Out-Of-Pocket Maximum Limits Your Exposure

Often people will have a fearful response when they hear that they will have to pay 20% or more for their medical expenses. They quickly do the math figure that if they have a $100,000 heart attack or stroke they will have to pay $20,000 towards their medical bills.

This is rarely the case. Your policy is likely to have an out-of-pocket maximum or stop loss provision that limits your exposure to a few thousand dollars. Not knowing this can cause you to undervalue a health insurance policy that has coinsurance and this may cause you to select the wrong plan.

Although it is important for you to understand the standard health insurance coinsurance definition, it is also important for you to know the other three things outlined above. Coinsurance percentages are not standardized, so you will need to know the exact percentage required for any policy you are considering purchasing. Out of network coinsurance is typically much higher than in network coinsurance. Your out-of-pocket-maximum or stop loss will probably limit your exposure to a few thousand dollars even if you have huge medical expenses.

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8 years ago · by · 1 comment

Health Insurance Copay Warning!

If the only health insurance copay you are familiar with is the small fees you pay to the pharmacy, please read on. Copays can be hundreds of dollars!

A health insurance copay is a flat fixed amount that you pay on a per service or per prescription basis. Since most people’s involvement with medical insurance copays is limited to relative pocket change, many fail to realize that copays can be much higher. Copays can cost your family thousands of dollars over the course of a year.

Medical insurance copays aren’t just for doctors’ visits and prescription drugs. You may find that your policy has a $75 copay for walk-in clinic visits or a $500 a day copay in the hospital. You should know exactly what your copays are and what they apply to before you purchase any health insurance policy.

Another thing that most people are unaware of is that the out-of-pocket maximum or stop loss provision of their policy will probably not limit their co-pays. This means that even though you may have met your deductible in May, you can still continue to pay copays for each doctors visit in December.

Also, if you are used to a policy that only has copays for certain medical services don’t assume that all policies work the same way. Some policies will make you meet your deductible for prescriptions. Others will pay for prescriptions after you pay a small copay. Others will have both a deductible and a copay on prescription drugs.

Do what you can to understand how any health policy you own works. This means that you should have a good understanding of the following terms:

  • deductible
  • coinsurance
  • copays
  • stop loss or out-of-pocket-maximum

You should also know how each of the above cost shares apply to any policy you own or are considering buying.

It is important to note that having a large copays or deductible are necessarily bad things. What is important is that you are able pay the right price for the coverage you get. If you are not aware of the differences between the cost shares in different policies, you can wind up selecting the wrong plan and paying too much.

Medical insurance copays are an important part of most health insurance policies today. Being aware of how they work and how they can impact your finances is important if you are going to make the right decision regarding your health insurance buying decisions.

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8 years ago · by · 2 comments

What is a deductible for health insurance?

A health insurance deductible is one of the most important aspects of a health insurance policy. To a large degree the size of your deductible controls your price. Understanding what a deductible is and how it is applied on any policy you are considering is important if you are going to make the right decision when looking to buy health insurance.

I have put together a video which answers the question What is a deductible for health insurance? Please click if you’d rather watch than read.

Not all expenses are subject to the deductible in every policy. In some policies, doctors’ visits and prescriptions are only subject to co-pays. However, don’t assume that this is the case for all policies because it isn’t. Many policies make everything subject to your deductible.

The amount of your deductible is the amount you will pay before your insurance company pays its share for medical expenses that are subject to your deductible.

If you have a $1,000 deductible and $2,000 worth of medical expenses, you will pay $1,000 before the insurance company opens its purse. The insurance company may or may not pay the remaining $1,000 in full. This depends on whether you have coinsurance on your policy. The remainder may be subject to coinsurance. If it is and your coinsurance percentage is 20%, your insurance company will pay $800 and you will pay a total of $1,200.

Your health insurance deductible is probably based on a year’s worth of expenses. This means that your $2,000 worth of expenses could have been the sum total of several doctors’ visits or one hospital visit.

The deductible-year may begin on January first. It may begin on your policy’s effective date or the anniversary of that date.

Knowing when your deductible-year begins is important when it comes to timing planned medical expenses. If you are nearing the end of your deductible year, you may want to delay going to the doctor for non urgent issues if you are a long way from meeting your deductible. By putting the cost of a non-urgent medical treatment or exam on next year’s deductible, you increase the chances of meeting your deductible next year. Of course the reverse is true. You may want to have your next medical visit earlier rather than later if you have already met your deductible for this year.

You pay for any expenses that are subject to your deductible. This means that your insurance company doesn’t pay for these things and will give you a lower price if you opt for a higher deductible.

However the difference in price isn’t usually proportionate to the difference in deductible. When you get a lower deductible you may wind up paying an extra $100 for each additional $50 worth of insurance. For this reason medium and high deductible policies are often the best buys.

Some insurance policies will have low deductibles and very high co pays or coinsurance. For this reason many zero deductible policies are misleading to consumers. And for this reason you should understand how those other cost-shares impact health insurance policies.

My next posts will cover those two subjects.

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8 years ago · by · Comments Off on Finding Maternity Insurance When You Are Already Pregnant

Finding Maternity Insurance When You Are Already Pregnant

Maternity insurance may be available to you from one of several places. Failing to investigate your options may result in your paying thousands of dollars out of your pocket for medical bills. The cost of delivering a child is very high today. You can easily rack up bills that are over $15,000.

You may be eligible for maternity coverage through your employer or your spouse’s employer, you may be eligible for a government-sponsored program and you may be eligible for a non insurance discount plan.

The first place to investigate is the group insurance options you may have. Group insurance policies are often available without medical questions.

Group insurance may be available from one of several places. You may have options with your employer. Your spouse may be able to add you to his or her coverage. If you are self employed you may be able to purchase a group plan.

If your employer offers group insurance, you may be able to get coverage during the next open enrollment period providing that the next open enrollment period is before your due date.

Be sure to look at options with your spouse’s employer as well. You may find that you are eligible to be placed on his or her policy. If you are not yet married, but plan to be before your baby is born, you may be able to request a special open enrollment period and not have to wait as long.

If you are self-employed, there may be policies that you cannot be denied for available to you as well. In many states, a company with one employee qualifies for group insurance. These plans will often have no medical underwriting so you may qualify even if you are already pregnant.

There may be government-sponsored programs that are available to you. You should check your options with federal, state, county and municipal programs. Many of these programs will cover women who are currently pregnant and dramatically reduce the out-of-pocket costs.

If you have exhausted the above options, you may want to investigate non-insurance policies that will help you get a lower rate from your local hospital. These plans allow you to get a discount on the hospital bill. You will still wind up paying a significant amount of money but you will be paying a lower rate.

You will have more and probably better options if you purchase health insurance that covers maternity before you get pregnant. Individual maternity insurance may offer you the best deal, but these plans are typically not available to women who are pregnant when they apply.

If you are currently pregnant, be sure to investigate all your options before giving up and being stuck with a big bill. Employer-sponsored health insurance may be available from your employer, your spouse’s employer, your future spouse’s employer, or from your business if you are self employed. You may also find that government-based programs are available to you through a local, county, state or federal government program. If you are not eligible for any of the above a non-insurance policy designed to lower your health insurance bill may be the best option for you.

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