Life & Health Insurance/co insurance
I am confused about the co insurance and co payment terms. I've looked it up on the internet and only get more confused.
My plan has a 20% co-insurance. So do I pay 20% of the cost of my plan or 20% of the bill?
As an example, let's say you have a $2000 deductible policy with 80%/20% co-insurance, with office visits costing $20 co-payment per visit, $50 co-payment for a specialist visit. The policy in this example has a $6000 maximum out of pocket limit, meaning the most that you are responsible to pay out of your pocket in a given year for all of your medical expenses is $6000. (The $6000 figure does not include premiums paid for the policy, but does include any deductibles or co-insurance.#
One day you awake and don't feel well, say an ear infection, and off to your general practitioner you go, paying the $20 co-payment for the visit. Your doctor suspects there may be more than a simple infection involved, and recommends an ear/nose/throat specialist. You go to the specialist, and for this visit you pay $50. Neither appointment requires that you meet your $2000 annual deductible first, or 20% co-insurance, you've simply spent $70 for two opinions thus far. Unfortunately, the specialist determines that you need surgery, the cost of which is $100,000. You are responsible for $6000, #max out of pocket,# of the $100,000 bill. You pay the $6000, have the surgery, and all is well.
Several months later you slip and break your wrist, #this just hasn't been your year Joyce!# The bill to fix you up, $4000. You are responsible for $0, you have already met your deductible and co-insurance for the year due to the cranial surgery.
Now it's 16 months later and you have not met your annual $2000 deductible, but are facing a $5000 bill for a broken arm. Of the $5000 bill you must first pay your $2000 deductible, and then 20% of the remaining $3000, or $600. The broken arm will cost you $2600 in this example, with $3600 remaining of your annual maximum out of pocket, #$6000-$2600=$3600.)
I have either answered your questions clearly and concisely, or made things worse! Hopefully the former. In the event that I have made things more confusing, please feel free to write or call with any additional questions you may have.