When talking to a healthcare provider about health insurance, they tend to throw around the words deductible, coinsurance, and copay, but do you know what they actually mean?
Deductibles, coinsurances, and copays are all words to describe the amount you owe for covered expenses when visiting a healthcare provider. Out of pocket maximum isn’t as common, but it is another term that plays a role in what you may owe for a visit.
Deductible: the amount you owe, out of pocket, before your insurance provider starts to cover part (or all) of your expenses.
Coinsurance: the percentage you owe of the total amount billed. For example, if you have a 20% coinsurance and are billed $100 for services, you would owe $20 to your healthcare provider.
Copay: a set dollar amount you owe for visiting a healthcare provider, regardless of the amount billed.
Out of pocket maximum: the maximum amount you pay before your insurance provider covers the rest of your expenses. This is usually a high dollar amount.
Keep in mind, deductibles, coinsurances, and copays are not mutually exclusive. Many plans that have a deductible also have a coinsurance after that deductible is met; plans that have a copay may also have a coinsurance for certain codes. Benefits may vary based on the type of provider seen as well. For example, you may have a copay to see your general practitioner but a deductible followed by a coinsurance at the chiropractor. Your benefits are entirely dependent on YOUR specific health insurance plan.
We are happy to do a complementary insurance benefits check for new and existing patients, and we will also explain your benefits quote to you if you have any further questions. If this is something you are interested in, either let us know in our office or give us a call at 515-450-8541 and we can get that process started for you.
For a more detailed explanation of these (and other) health insurance terms, see the glossary on healthcare.gov .
https://www.healthcare.gov/glossary/