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Health Insurance Terms 101: Understanding Deductibles, Coinsurance, and Copays

Health Insurance Terms 101: Understanding Deductibles, Coinsurance, and Copays

March 27, 2019

Navigating the health insurance industry independently can be overwhelming at best. At Larry W. Payne Nationwide Insurance, we are here to make shopping for a new health insurance policy a little bit easier by going over some of the most common terms used when talking about medical coverage today: deductibles, coinsurance, and copays.

Health Insurance

Deductible: The deductible on your health insurance policy is the amount you have to pay to receive healthcare services independently before your insurance provider assists with some of the expense. If, for example, your plan had a deductible of $2,500, you would pay 100% of your medical bills until you pay $2,500 for care. Then, you begin sharing the cost of healthcare with your insurance provider through copays and coinsurance for the rest of the calendar year.

Coinsurance: Once you have met your deductible for the year, your coinsurance is the portion of the costs you share with your insurance provider. In many cases, your coinsurance is described using a percentage. For instance, let’s say you have to see a dermatologist regularly. Once you meet your deductible, your insurance is applied and pays 70 percent of the cost of your visits. The remaining 30 percent of the cost, or your coinsurance, is paid by you.

Copay: A copay is a set amount you pay for a particular healthcare service, typically when the service is received. Copays can vary depending on the type of service needed and often apply when you fill a prescription.