Deductibles and Coinsurance


Any time you or a loved one experience a medical issue, it can be a stressful time for the entire family. To avoid adding extra anxiety to the situation, you’ll want to plan ahead to understand how your insurance coverage works. A good place to start is by learning what the differences are between a deductible and coinsurance.
The amount that you pay out-of-pocket for health care costs before your plan begins to pay is the deductible. The specific expenses that can be contributed toward the deductible will vary depending on your particular plan, but typical examples of qualifying medical expenses include doctors’ office visits, lab tests, surgical procedures, hospitalizations, rehabilitation expenses and prescription medications. There may be an individual deductible, and, if you have dependents on your plan, a separate family deductible.
Once your deductible has been met, you might be required to pay a percentage of certain medical bills. This percentage is the coinsurance. If, for example, you have a bill that is $200 and your coinsurance is 20%, then the amount that you owe would be $40. You will continue to pay the coinsurance on any bills until you reach your plan’s out-of-pocket maximum. Once the out-of-pocket-maximum has been met, the plan will cover 100% of your health care costs for the remainder of the plan year.
Whether you only visit the doctor for annual exams or you have an unexpected trip to the emergency room, you can help protect your pocketbook by fully researching your insurance plan now.
Source: Cigna