Health insurance can be confusing.
Some of us end up paying too much for coverage we don’t need. Others delay or avoid medical care because of cost. Enrollment can be challenging and frustrating. Then, we begin the new year in January hoping to avoid serious illnesses (i.e., medical expenses), but that doesn’t always happen.
Health insurance plans vary. Your best bet if you have questions is to contact your insurer. But we’ll explain some basic insurance terms to help you understand how the process works.
Premium
It’s what your coverage costs each month. If you’re in an employer-sponsored plan, you may, for example, pay 20% of the premium and your employer pays 80%, depending on your plan. You’ll always pay at least this amount each month, regardless of how much or how little healthcare you receive. In most cases, it’s deducted from your paycheck.
Deductible
It’s how much you must spend for covered healthcare services before your health plan starts to pay for anything beyond no-cost preventive care. With a $2,000 deductible, for example, you pay the first $2,000 of covered services yourself. After you reach your deductible, you’ll typically just pay a copay or coinsurance.
Family plans often have both an individual deductible, which applies to each person, and a family deductible, which applies to all family members.
Copay
A flat fee you pay for specific services covered under your health care plan, often paid when you’re checking out following an appointment. Copays may apply whether or not you’ve met your deductible.
Coinsurance
A percentage of the cost that you’re responsible for paying when you receive a specific service. Coinsurance may apply whether or not you’ve met your deductible. People often confuse coinsurance with copays, but they’re different. Your plan may have copays or coinsurance – or it may have both. Example: You’re billed $500. If, say, your plan makes you responsible for 30% of the cost, you’d pay $150 and the health insurance company would pay 70%, which would be $350.
Out-of-pocket maximum
This is the most out-of-pocket cost you’ll have to spend (cumulative) for most covered services within that year. After you reach this amount, your health plan pays 100% for the most covered services. You’re only responsible for paying your monthly premium and, depending on your plan, copays and/or coinsurance.
Here at Keith Clinic Estramonte Chiropractic, we’re happy to discuss your insurance coverage before or after a visit. Call an insurance specialist at any of our clinics – 704-392-3000 (Freedom Drive), 704-940-4000 (Central Avenue), 704-405-7000 (Sugar Creek), or 704-275-5477 (South Blvd.)