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First of all co-insurance is not “co-pay.”
Co-pay is the money you pay to the doctor in the USA for an office
visit. Co-insurance is not “deductible.” The
deductible is the amount of money you are required to pay for
medical expenses before the insurance kicks in and starts providing
reimbursement for
medical costs.
“Co-insurance” is called “Co” because it includes a sharing of
medical costs between the client and the insurance company.
Co-insurance amounts are
stated as percentages; for example, 90/10, 80/20, 70/30, 60/40,
50/50. The most common co-insurance percentage is 80/20. What this
means is that the company will cover 80 percent of the medical
expenses after the deductible, and the client will cover 20 percent
of the medical expenses after the deductible. Almost always a cap is
put on the amount that is to be covered by the co-insurance, usually
$5,000 but sometimes $10,000.
So if you have an insurance plan with a $1,000 deductible and
co-insurance at 80/20 with a cap at $5,000 in a worse case scenario
you would need to pay
out $2,000. Here is how it would work: You would obviously pay your
$1,000 deductible. Then you would also pay 20 percent of the next
$5,000, which
would be $1,000. The insurance company would pay the other $4,000
and all expenses beyond $5,000.
Remember as your portion of the co-insurance increases, your monthly
premium will drop. Thus a 50/50 plan will be less expensive than an
80/20 plan. |
