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                                                           A Guide to Health Insurance






















When both you and your health insurance company pay part of your medical expense, it’s called cost sharing. If you understand how deductibles, Coinsurance, Co-pays works as it will help you know when and how much you have to pay for care.



Deductible Insurance


A deductible is the amount you pay for health care services before your health insurance begins to pay. Let's say your plan's deductible is $1,500. That means for most services, you'll pay 100 percent of your medical and pharmacy bills until the amount you pay reaches $1,500. After that, you share the cost with your plan by paying coinsurance and copays. A plan with a high deductible will have cheaper monthly payments. But you'll pay a lot upfront when you need care. You can also look for plans that cover some services before you pay your deductible.This is the portion of your medical expenses that is not covered by a copay and you are responsible for 100%, until you reach your deductible. It's like car insurance. Should you need to, you pay your deductible and then insurance kicks in to help pay.

The basics about annual health deductibles:


Expenses related to hospitalization, surgery and procedures are typically applied to your deductible first. Lab tests, MRIs, CAT scans, surgical costs, anesthesia, physical therapy, medical devices usually go toward your deductible first. Charges for mental health, chiropractic care and other services may also go toward your deductible first. Premiums are not applied toward the deductible. Deductible amounts are different for individuals and families. Deductibles are much lower if you see in-network versus out-of-network (outside the network) providers; if you go out-of-network, you will have an out-of-network deductible which is higher and separate from the in-network deductible.

Choosing a high- or low-deductible plan:


In choosing a plan, you want the best value for your money. You ask: Which is better, a higher deductible or a lower deductible?
High deductible: To get a lower monthly premium, some people look for plans with a higher deductible. When does this work best? If you had very few medical expenses last year, you probably didn’t reach your deductible. If you feel that will stay the same for the coming year, a plan with a higher deductible may be the right fit. Low deductible: For active families, a lower-deductible plan might be a good choice. If the kids are in sports—or someone has a chronic health problem, with lots of medical and emergency visits—it may be worth paying a higher premium to get a lower-deductible plan, with lower co pays.



Coinsurance:


Coinsurance is your share of the costs of a health care service. It's usually figured as a percentage of the amount we allow to be charged for services. You start paying coinsurance after you've paid your plan's deductible. Here’s how it works. Lisa has allergies, so she sees a doctor regularly. She just paid her $1,500 deductible. Now her plan will cover 70 percent of the cost of her allergy shots. Lisa pays the other 30 percent; that's her coinsurance. If her treatment costs $150, her plan will pay $105 and she'll pay $45.If Lisa has a PPO plan, she has the option to see any doctor she wants. If she goes to an out-of-network doctor, her plan will still share the cost, but her percentage of coinsurance will be higher. And, if the medical service she gets is more than what her plan would pay for an in-network doctor, she'll have to pay the difference. Typically, the lower a plan's monthly payments, the more you'll pay in coinsurance. When you reach your deductible, you must pay a percentage of the remaining costs—this is the coinsurance amount. Let’s say you have a policy with 20% coinsurance. That means the insurance company will pay 80% of covered services after your deductible has been met and you pay the remaining 20%. But you won’t have to pay that 20% forever. You pay until you reach your out-of-pocket maximum—perhaps $6,350, depending on your Insurance company healthcare plan. Then, the insurance company will cover the rest of qualifying medical expenses for that calendar year.

Co-Pays :


This is a fixed amount you pay for a health care service, usually when you receive the service. The amount can vary by the type of service. You may also have a copay when you get a prescription filled. For example, a doctor’s office visit might have a copay of $30. The copay for an emergency room visit will usually cost more, such as $250. For some services, you may have both a copay and coinsurance.Type your paragraph here.

Dr. VISHALAKSHMI BATCHU , MD
Internal Medicine