What is a co-insurance max? (health insurance)?

Question

It says my co-insurance max is $1500 and my copays apply to that. What does that mean?

Answer 1

First of all, that IS a really cool avatar. Is it your cat? I should do that.

Second, it says if something big happens, like open heart surgery, the most you have to pay in coinsurance is $1500, but after you hit $1500, you dont' have to pay the copays to the doctor for office visits any more.

Scotty is confusing "deductible" and "coinsurance". Deductible is what you pay out of pocket, before the insurance kicks in. Copay is the $25 you pay for every office visit. Coinsurance is the portion of every large claim that you pay - usually it's 80/20 - ie, you have a $5,000 appendectomy, your responsiblity (co-insurance) would be $1,000.

Answer 2

That means that no matter how much medical care you seek, you only have to pay out $1500 total. For example - let's say you have $30 office visit copay. You were in the hospital, and your portion of the bill came to $1000. This means that when you go to the doctor - let's say you go every other week for some kind of treatment - you will only have to pay copays on the first 17 visits - because by then, you'll have shelled out the entire $1500. (the $500 remaining after the $1000 hospital bill - 500 divided by 30 is 16.7)

Answer 3

you're lacking 3 considered necessary issues: a million. coverage cut back. with out coinsurance (which skill no out of pocket max), and $one hundred sixty a month, you are going to have a optimum income quantity. If it incredibly is $5,000 for surgical treatment, then you quite pay the 1st $a million,000, plus each and every dime after the coverage will pay their $5,000. 2. income form - at that top type, you at the instant are not getting any sort of maternity coverage or fertility coverage. What precisely do you go with the surgical treatment for? it may flat out be excluded. 3. Preexisting situation - those are tremendously plenty all excluded. As you already know NOW you go with the surgical treatment quickly, odds are, the completed technique is going to be excluded from coverage as preexisting. with out coinsurance, you do no longer could concern approximately an out of pocket max . . .however the kind of coverage that provides you no coinsurance, limits the income quantity.

Answer 4

Your coinsurance max is your maximum out of pocket. Copays for docs and Rx go towards your MOOP. Once you reach your $1500 you won't pay a copay.

Answer 5

co-insurance is what YOU have to pay out-of-pocket before insurance kicks in and pays everything.

First, you have to meet your deductible. You pay 100% of all qualified expenses until you've met the deductible. Then, you have co-insurance...you pay 10-30% while insurance pays 70-90%. After you've paid $1500 out-of-pocket (including your co-pays), then insurance will pay 100% of everything after that.

EDIT: Actually, with all due respect to "mbrcatz17", I'm NOT confusing co-insurance and deductible. I'm simply saying that the deductible applies before any coinsurance is counted. You have to meet any deductible first. Then, you pay co-insurance along with the insurance company payments, until you've paid a maximum of $1500 out-of-pocket. Once you've paid $1500, the insurance company pays 100% of covered medical expenses.

If you truly have a policy that allows you to INCLUDE office-visit co-pays in your coinsurance, that's a good policy. Most healthcare policies specifically exclude co-pays in the co-insurance.

Answer 6

I agree with scott