Out-of-Pocket Maximums & Copayments -The Basics

Your Annual Out-of-Pocket Maximum – The Maximum Amount You Will Pay Each Year

Your annual out-of-pocket maximum is the absolute maximum amount of money you will pay for covered services during a year. One you reach your annual out-of-pocket
maximum, your health insurance plan covers your medical costs at 100 percent.

Your Copayment- The Cost of a Doctor Visit or Pharmacy Item

Your co-payments (or copays) are set dollar amounts you to your medical providers for specific covered services. The most common types of copay’s are doctors
visit copays and pharmacy copays. For example, you may make a $30 copay for  each covered visit to your pharmacy copays. For example, you may make a $30 copay
for each covered visit to your primary care provider. Often, copay are capped at
a certain number of uses per year.

Annual Deductible & Coinsurance – The Basics

Over the next few weeks we will go over “The Basics” terms in insurance. So you will have the ability to shop and compare different options, especially when getting new health insurance. Today’s terms is Annual Deductible and Coinsurance.

Your Annual Deductible –  The Amount you Pay before your Coinsurance Kicks In.

Your annual deductible is the amount you must pay for covered care each year before your health insurance begins to pay. For example, a $2000 deductible will require you to pay $2,000 out-of-pocket for covered services before insurance company pays.

Your Coinsurance – The Amount You Pay after Deductible

Your coinsurance is the percentage of medical cost you are required to pay after  your annual deductible is met. For example, the health insurance plan may cover 80% of charges for a covered surgery, leaving you responsible for the other 20%. The 20 percent you must pay is called the coinsurnace

Tomorrow we will cover “Out-of-Pocket Maximums”

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