Finding health insurance seems like it gets more and more complicated every year. There are many unfamiliar terms that make it hard for the average person to understand what’s covered and what’s not under the plans they’re considering. Much of the time, plans differ by the level of the deductible and the amount of copay or coinsurance that customers have to pay. Here is an explanation of those terms for a better understanding of exactly what you’re buying.
- Deductible. This is the amount you owe for services your plan covers before the insurance company will pay a claim. For example, if your deductible is $1,000, you will have to pay that amount before your coverage kicks in. However, it doesn’t apply to all services, which means that some things, like preventative care or doctor’s visits, may be covered before you’ve reached that $1,000 mark.
- Copayment (COP) vs. coinsurance (COI). COP and COI are two ways that health insurance companies can share the cost of the services with the patient. While they both have the same purpose, they’re a little bit different. COP is a fixed amount that you pay whenever you get a specific service. For example, a visit to your primary care doctor will cost you $20 every time you go. You may also pay $10 for each generic prescription that you have filled. COI, on the other hand, is a percentage of the cost of the service rather than a fixed number. For example, with COI, you will be charged 20% of the cost of the visit if you see your primary care doctor, and the cost of the visit will vary depending on the nature of the treatment during that visit. Likewise, for a generic drug, you would pay a fixed percentage that would vary by the drug’s cost and its tier. Most companies negotiate discounted rates with physicians and pharmacies, which means that you’re usually responsible for a percentage of that discounted rate.
- Prescription drugs. The difference between COP and COI can be confusing when it comes to pharmaceuticals because of the different drug tiers. Each health insurance plan will come with a drug formulary to help you understand what you’ll be paying for in that area specifically.
While these health insurance terms can be confusing, it’s important to know what you’re buying before you buy it, and this product is no different. There have been many changes recently in the way we think about coverage, which means that many people have encountered terms and conditions that they may not necessarily understand. Each person is different, and their personal well-being and their required level of treatment and maintenance will be different as well, which is why it’s important that you choose the plan that best fits your needs. An understanding of the above terms is an important first step in this decision.