Post by cinderbella on Aug 3, 2015 19:30:57 GMT -5
You have to satisfy your deductible before your coinsurance kicks in.
So if you have a $500 deductible then 80/20 plan, you're responsible for the first $500 before your 20% kicks in.
Eta: there are some things that don't apply to the deductible though - so watch out for that. Usually copays for both office visits and rx don't apply,though they will apply to the oop max.
Post by snipsnsnails on Aug 3, 2015 19:32:35 GMT -5
A deductible is the threshold of money within a calendar year you need to reach before co-insurance comes into play.
Example: Deductible: $1000 Co-Insurance: 80%/20%
In 2015, you will owe for all approved medical procedures up to the first $1000. After that, any procedure will be split between you and your insurance. They'll pay 80% of the cost and you'll pay 20%.
Yep. You meet your deductible and then co insurance kicks in. So instead of paying $100 for a dr visit you would pay $20 if it is an 80/20. Then there is usually an out of pocket max.
"Why would you ruin perfectly good peanuts by adding candy corn? That's like saying hey, I have these awesome nachos, guess I better add some dryer lint." - Nonny
And what's a co-pay? Is that when you and your spouse share the cost that the 20% (or whatever) doesn't cover?
Co pay is a flat fee for receiving services. So, if I see a doctor, it'll be 20 bucks every time before I can be seen, or if I get a generic prescription, it'll be 9 dollars for each prescription.
And what's a co-pay? Is that when you and your spouse share the cost that the 20% (or whatever) doesn't cover?
Co pay is a flat fee for receiving services. So, if I see a doctor, it'll be 20 bucks every time before I can be seen, or if I get a generic prescription, it'll be 9 dollars for each prescription.
"Why would you ruin perfectly good peanuts by adding candy corn? That's like saying hey, I have these awesome nachos, guess I better add some dryer lint." - Nonny
Also in the explanation there is a dollar amount listed under co-insurance. Does that max out as well like a deductible? So once I reach the amount listed I don't have any OOP expenses except co-pays? Or am I misunderstanding.
Post by cinderbella on Aug 3, 2015 21:33:49 GMT -5
You're correct. Once you it the oop max, covered services are paid at 100%. Just check for exclusions and make sure you're staying in network - usually copays are the big one that confuse people.