health insurance?

Question

i have PPO option with a $1500 deductible with co-insurance (no co-pay). What does co-insurance mean? Would I have to bear the expenses for the 1st $1500 I spend for my health treatment/prevention? This is too much for me to bear- this insurance is worse than what I had when I was in school

Answer 1

Yes, if your policy states that you have a $1,500 deductible, you will have to pay that until it's been met (paid by you in full). Some policy's do not count some preventative care towards the deductible. You will have to check your policy. You say you have a $1500 deductible with co-insurance. Check your policy-it should state what the percentage is that they cover and what the maximum out of pocket you will have. Example:they pay 80% to $3,000 out of pocket.

Answer 2

In addition to you having to bear the expense of the 1st $1500, co-insurance means that the insurance would pay only a percentage of the remaining bill, and you would be responsible for the rest. Typically the split is 70/30 or 80/20, with a maximum out-of-pocket limit. This is your true cost.

If this is a HSA-qualified plan, the limit must be less than $5500. Also, some of these plans will provide preventive care at no charge.

The reason that many of these plans are so popular today is because they will help control the cost of the benefits. Your employer may offer some kind of contribution to your out-of-pocket expenses. Check with your HR department.

If this insurance does not make sense for you, make sure that when you are interviewing for a new job that you ask about the insurance that is being offered and the out-of-pocket expense, as well as your cost-share of the premium.

Answer 3

Coinsurance is the amount that you are obliged to pay for covered medical services after you've satisfied the deductible required by your health insurance plan. So you would pay the first $1500 of medical expenses since that is your deductible amount. Coinsurance is typically expressed as a percentage of the allowable charge for a service rendered by a healthcare provider. For example, if your insurance company covers 80% of the allowable charge for a specific service, you will be required to cover the remaining 20% as coinsurance.
Now, if you are looking for a low deductible plan, with a low monthly premium, check out Precedent, a new company offering low cost individual health plans in Texas for young, reasonably healthy people. You buy into a plan at a super low cost with fixed benefits that will cover the typical activities and preventative care of a healthy person. Then, if something catastrophic happens, you have the option to get additional levels of coverage, even AFTER the event. A healthy 25-year-old male (and under) would pay under $100 a month for basic coverage. Check them out at http://www.precedent.com - Even if you’re not in Texas, my understanding is that they’ll be offering plans in additional states soon. I hope you find what you need!

Answer 4

Co-insurance is the percentage of the allowable charges that you pay. For example, most policies are 80/20. This means that after you pay the $1500 deductible you pay 20% of the charges until you reach a maximum amount.

There are thousands of variations on policies. You'll need to contact your agent or the HR department at work if it's a group policy for more explanation about your particular policy.

Answer 5

It means that you pay the first 1500 of medical charges per year. Once you meet the deductible, your health insurance will pay a % (such as 80%) of the charges and you will pay the rest (such as 20%).

You may want to see if your company offers a health savings account. If not, your local bank may offer them. To qualify for an HSA you have to have a high deductible health plan. This allows you to set money aside for your deductible. I believe it also has tax advantages.

Answer 6

If you have coinsurance, you will pay a certain percentage of the total costs after you pay 100% of the total deductible. There is probably a different coinsurance level for "in-network" and "out-of-network" coverage.

Many PPO plans have benefits not subject to the deductible. Doctor office visits are an example. You need to check the summary plan description.

Answer 7

Yes, you pay the first $1500 (per year) out of your pocket. Co-insurance means you and your insurance company share costs above $1500—often on an 80 (them)/20 (you) basis. Check your policy for details.

Since you already have a high deductible, you might consider getting a government-qualified High Deductible Health Plan (HDHP). Under federal law, the minimum deductible in a HDHP plan is $1,100 for an individual and $2,200 for a family. The advantage of an HDHP is that you can shelter up to $2,850 for an individual or $5,650 for a family per year from state and federal taxes in a Health Savings Account (HSA), then use that tax-free money to pay the deductible and your part of co-insurance. Depending on your tax bracket, that could save you as much as $2,374 in taxes per year, assuming a combined tax rate of 42.02%—6.37% in state income tax (New Jersey), 28% in federal income tax, and 7.65% in Federal Insurance Contributions Act (FICA) tax. In other words, you increase your buying power by 42% by using tax-free dollars to pay your deductible, rather than using dollars with taxes taken out. The contributions you make to an HSA are yours to keep, rolling over from year to year. The funds remain untaxed as long as you use them to pay medical expenses or withdraw them after age 65. The funds earn interest on a tax-deferred basis. Think of it as an IRA that you can use to pay out-of-pocket medical expenses.

Answer 8

You need to call them and ask, there should be a 1-800 # on the back of you card