Looking to purchase health insurance, but confused when it says 20% after deductible?

Question

For example, If the deductible was $2,000 and I pay that when my coverage begins. So if I was planning to see a doctor and my coverage was 20% coinsurance after deductible, what does it mean? If you could give an easy example, it would be very helpful, thank you!

Answer 1

Co-insurance is kind of a sneaky way to increase your costs. First you pay the deductible, then you pay 20% of the bills until you meet the out of pocket maximum. Sometimes the out of pocket maximum includes the deductible, sometimes it doesn't. Check the policy. If you have co-pay doctor visits & prescriptions, the co-pays are not subject to, nor do they apply towards the deductible or co-insurance.

Example:

Laura has an insurance policy with a $1,000 deductible, 80/20 coinsurance with an out of pocket maximum of $2,000, and co-pays of $30 for doctor visits and prescriptions. The deductible is not included in the out of pocket maximum.

Laura was hospitalized for three days.  The bill came to $6,000. Laura pays the deductible ($1,000) and then 20% of the remaining $5,000, which is $1,000. So, laura has spent $2,000 so far, and the insurance company has paid $4,000.

After being discharged laura also spent $30 at a time for follow up visits with her physician and for prescriptions, that are separate from her deductible and co-insurance.



This is not a good example because in reality 3 days in the hospital really costs $20,000 to  $50,000, but is serves as an illustration.

Don

http://mtnhealthinsurance.com

Answer 2

Until you pay in the whole amount of the deductible, you will be responsible for 100% of the doctor's discounted charges.  (Usually when they are a member of the HMO or PPO, they charge less than non-insured patients.)  So, until you pay out of your pocket $2000, then the insurance company won't pay anything.  After there's $2000 out of your pocket, then the insurance company will pay 80% of the discounted charges and you will have to pay 20%.

Look at an estimated year's worth of your expenses.  On this plan, add up your monthly premium, $2000, and an estimate of your doctor and hospital charges and take 20% of that.  Divide by 12 to see what the real monthly cost is.  The lower deductible may be a better coverage as long as the monthly premium is not so high it means your annual expenses are higher.  Add it up and compare side by side.

Answer 3

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Answer 4

the health insurance provide 20% after deductible means your premium will be decrease every year

Answer 5

It sounds like you have to pay all your medical bills until the total reaches $2000. After that you have to pay 20% of any bill and the insurance pays the rest. Sounds like poor coverage to me.

Answer 6

Hi there,

Everyone's answers are correct.  The one thing I would add to the answers is this.  When is says 20%, they're talking about going to a provider who is contracted with your Health Insurance plan.  If you're going to a doctor who doesn't take your health insurance plan, you're going to pay a much higher percentage of the billed amount, and you're not going to get as much credit towards to your deductible for those services.  

Just check and make sure that you KNOW whether or not you're going to a contracted provider or not.  

KNOWLEDGE is the best way to go.  Good luck.

Kathy K

www.premiumwatchdog.com

Answer 7

It means that you pay the first $2,000 (the deductible part).  And then you pay 20% of the allowed amount for services after that.

Check to see if there is something called an "out of pocket maximum" or "coinsurance maximum" on the plan.  That means there's a cap on that 20% after your deductible is met.

For example, if the plan had an "out of pocket maximum" of $1,000, it would mean that you would potentially be liable for $3,000 in covered services.  (The $2,000 deductible + the 20% of services up to a maximum of $1,000.  Non-covered services, of course, would be your full responsibility.)