Ever feel confused by your health care plan?
What’s a copay? A deductible? An out of pocket maximum? How does my plan work if I have to go to the Dr.?
Here are some simple ways to understand how it works and get some peace of mind!
Preventive care: Yearly checkups, preventive tests and other things that keep you healthy!
Copay (Copayment): When you see a Dr., most plans have you pay a certain amount to the Dr. for the visit; it is a fixed dollar amount paid to your Dr. This amount generally does not go toward your deductible or out of pocket maximum.
Deductible: You pay this amount for covered services each calendar benefit year before the plan pays their portion. Covered services that would apply to the deductible may include labs, x-rays, surgeon and hospital fees.
Coinsurance: Once you’ve met your deductible, the carrier will start paying a portion of claims. The health care bills that remain are shared between you and the carrier, this is called coinsurance. The carrier generally pays between 50% and 100% of the bill.
Out of pocket maximum: Every plan has an out of pocket maximum. The amount you pay in deductible and coinsurance are typically what make up your out of pocket maximum. Once you meet your out of pocket maximum the plan pays 100% of covered services for the rest of the calendar year. With some plans, however, Dr. visits and prescriptions are required even after the out of pocket maximum is met, be sure to check your specific plan requirements.
QUESTIONS??? Give me a call and I am happy to explain further! In general, the lower your deductible, copay and/or coinsurance, the more your premium. Keep this in mind when you’re thinking about the right plan for you!
Kim Brewer, Steven J. Erickson Insurance (619) 337-9980