![]() Out-of-pocket maximum: This is the absolute maximum you are expected to pay in cost sharing within a plan year. So, if you see the doctor for this type of office visit 15 times, but at least 11 of those 15 visits are not within the same plan year, your insurance will not pay anything against his or her fees. The deductible starts over every plan year. In fact, you would pay the entire amount for 11 such visits ($1000/$85 = 11.8) before your insurance began to pay anything to the doctor directly. If your insurance has a $1,000 annual deductible, you would pay the entire $85 allowable to the doctor. For example, if your coinsurance is 20%, you would pay 20% of the $85 allowable (0.2 x $85 = $17) to the doctor, and the insurance company would pay the remaining $68 ($85-$17 = $68).ĭeductible: With a deductible, you pay the entire amount allowed for all services provided until the deductible is met. You may have a copayment for emergency room services check your plan for details emergency services for non-emergency problems.Ĭoinsurance: In a coinsurance model, you pay a fixed percentage of each service. For example, if your copay is $40, you are expected to pay $40 and your insurance will pay the remaining $45 ($40 + $45 = $85). Types of Cost Sharing Arrangements & Situations How much is paid by the insurance company, and how much is your responsibility, depends on your plan's cost sharing arrangement:Ĭopay: In a traditional copay plan, you pay a fixed amount per service. Cost sharing varies with different types of health plans, but most will have a copayment, coinsurance or deductible amount. ![]() This is called "cost sharing" or "out-of-pocket" costs. By: Suzanne Berman, MD, FAAP & Angelo Peter Giardino, MD, PhD, FAAPĪll health insurance requires consumers to pay some of the cost of covered health care services.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |