Co-pay/Co-insurance Costs of Your Benefit Coverage: How does it work
- ourneighborshealth
- May 3, 2023
- 3 min read
Updated: Jul 14, 2024
Health Insurance
As a licensed Life/Health insurance agent and consumer I've been in both sides of the spectrum when it comes to choosing a plan where it fits my budget when going to the doctor's office, choosing providers, etc. For the age group 64 and under the costs of insurance can be higher than our mature groups ages 65 and older. Instead of not choosing a plan get to know what's available then make your decision. Too often I've seen people in good health experience illness, accidents, or pass away and not have a health or life insurance plan in place.
Which plan to choose, bronze, silver, gold. Original Medicare, Medicare Supplement, Medicare Advantage, Medicare Advantage Prescription Drug Plan
Tip #1 -Co-pay, Co-insurance, Deductible
Co-pay is a fix dollar cost you pay each time you use your benefits
Co-insurance is a percentage of total cost of your share
Deductible is dollar amount of your costs before insurance company starts paying a benefit coverage
Example: RST Insurance Company has a $100 (medical) deductible to be met in a benefit year before your cost are just co-pays or coinsurance.
Office visit: $120 1st visit of the year 01/01/2024 or when you schedule your first appointment of the year. You pay $100 (deductible has been met) balance $20 goes as your co- pay.
Your next office visit let's say is billed for $138.00 your cost ($20 copay) and that's all.
What the contracted rate with RST Insurance Company and provider is what RST Insurance Company allows and will pay that amount.
If your plan has a coinsurance for the same office visit first appointment of the benefit year
$120 your cost. Next office visit $138.00 your cost would be $ 27.60
138.00 x 20$ = 27.60
These are just examples some plans deductible are higher or there are no deductibles to be met
Bronze, Silver, Gold, Platinum ages 64 -under
Bronze- $0 to low monthly premium. Costs are higher when you need care may also include plan deductibles to be met before insurance plan starts to pay. This choice is for if you want a low-cost plan.
Silver - Bearable monthly premium. Qualifying for cost-sharing reductions choosing a Silver plan you can get extra savings also if your eligible for premium tax credit.
Gold - Higher monthly premiums, lower cost when you need care, good choice if your willing to pay more each month to more costs covered when you get medical treatment.
Platinum- Highest monthly premium, deductibles are very low, insurance plan starts paying its share earlier than other metal plans.
Tip #2 - Original Medicare, Medicare Supplement, Medicare Advantage, Medicare Advantage Prescription Drug Plan ages 65 -up
What is the difference right? All Medicare Beneficiary will have
Part A and this covers your hospital, skilled nursing, hospice, and home health care.
Part B (monthly premium required) is for your doctor's visits, labs, outpatient care, physical and occupational therapists, etc.
Part C is for medicare advantage plans that covers yours hospital, doctor's, labs, additional benefits, and prescription. Must have Parts A/B to enroll in these plans
Part D covers prescription medication.
Medicare Supplement Insurance Plans
(additional insurance coverage with private insurance carriers)
Part A/B are required
Ten 10 different Medicare Supplement Insurance plans A-D, F, G, K-N difference is costs of plans
Covers co-payments, co-insurance and deductibles
"Have a healthcare plan in place just in case" like an accident or sickness
Tip #3 - Enrolling In A Plan
Enrollment for healthcare plans on the healthcare market exchange, state exchanges or directly with insurance companies for ages 64 and under. Ages 65 and up you can enroll with a broker or directly with insurance carrier also. Healthcare Insurance Agents can guide you in choosing a plan that fits your healthcare needs and your budget.
Tip #4 - Sometime you have to do what you have to do
During today's changes in healthcare lay offs, employment changes, business restructuring, re location and on there are options of selecting short term plans.
Tip #5 - Knowing the Difference
Remember what you need and what is available than you can make educated decisions on what healthcare plan works for you and your lifestyle.
Choosing a healthcare plan can be stressful, especially if you've never enrolled yourself or recently retired and don't know what your choices are for a Medicare Healthcare Plan.
Have any questions we are here to help
For further information contact: 877.663.4240
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