Deductibles and coinsurance???what is it???

Question

can you please explain what it is? and lets say a plan for an insurance states the following...$30 copayment, 70% (insurance) and 30% (you) coinsurance, $5,000 family deductible.

Answer 1

A co-payment is usually for an office visit or ER visit. There is nothing else that you would owe for that service.

A deductible is the amount that you would have to pay before the insurance covers their portion (in this example the 70%)-after the deductible is met, the insurance pays 70% you owe 30% to whatever the maximum out of pocket is. Usually there is an individual out of pocket max and if this is a family policy, usually if 2 members meet the out of pocket max, then the rest of the family is covered at 100%. These percentages are usually based on a contracted (reduced) rate that the insurance company has agreed to pay--so you will have to wait until they process the claim and the provider subtracts the discount before you know what you will really owe.

Answer 2

Co-pay- The set fee you pay when visiting a preferred Provider

Deductible-

Amount you pay beyond regular Dr Visit before the insurance company begins to pay 70%. A family deductible means any care the family gets adds up towards the combined $5,000 deductible.

Co Insurance- After  satisfying the deductible the insurance company requires you to pay a percentage of the bill. In this case you pay 30% the insurance company pays 70%

Maximum out of pocket.-The maximum amount in any given

year you would pay beyond premiums for co-pays, deductibles and coinsurance.