No one wants to say the “D” word…..DEDUCTIBLE!
Most everyone knows that their insurance plan has a deductible. A deductible is a set amount of money that is the patient/member/subscriber’s responsibility before the insurance will begin to pay towards covered services.
They either reset every Calendar year (every January) or Fiscal year (anniversary of the effective date of the insurance plan). It is important to know your insurance benefits and deductible amounts. Deductibles range from $50 to $6,000 and sometimes more depending on the company and the plan you choose.
For services that are considered covered benefits of the insurance plan, there will usually be a coinsurance (coinsurance is a shared cost with the insurance company) that comes into effect after the deductible is met. For example, say you have a $500 deductible and it has been met (meaning you have spent $500 on covered services). The out of pocket cost for covered services after $500 has been met, turns into a 90/10, 80/20, 70/30, etc., This means that the insurance company will cover 90% of the charges/costs and you are responsible for the remaining 10%. This will vary depending on the plan you have. If it is the 80/20, insurance covers 80% and you are responsible for 20%….etc.
Don’t confuse coinsurance with a co-pay. They are two different things. Coinsurance is a percentage of the cost for a health service and a co-pay is a flat fee for a service.
Be prepared in the new year for your medical expenses and check your insurance plan’s benefits!