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- State Farm Bank® Full Service Financial
I know I want a PPO for an individual. But can someone explain terms such as "co-insurance", "copay" and "deductible"? They sound like the same thing. Sounds like "what you have to pay when you go to the doctor". But obviously the terms don't mean the same thing. PLEASE no stupid answers. Telling me "it means you pay" really doesn't help me. If you can't give me a real answer, then don't give me ANY answer.
The copay, is how much you pay for every doctor visit. Every time. The deductible, is how much you pay, every year, before the insurance starts paying. The coinsurance, is how much of every claim you pay, AFTER you've paid the whole deductible amount. As an example, if you have a $10,000 deductible, and have a $5,000 operation - you pay the whole $5000. If you have an 80/20 coinsurance, and have a $20,000 operation, you pay the first $10,000 (deductible) and 20% of the second $10,000, or $2,000. There's ALSO going to be a maximum out of pocket amount - the most you'd have to pay, no matter HOW high the bills go. Keep in mind, many times that office visit is OUTSIDE of the deductible - but any testing you'd have done, is INSIDE the deductible. I'd strongly suggest that since you're a bit fuzzy on terms, "do it yourself" health insurance isn't a very good idea. Use a local broker. It won't cost you any more, and they'll be able to explain ALL the options, BEFORE you buy it. Waiting until AFTER you've got $50,000 in unpaid medical bills, to learn about WHY they weren't covered - isn't a very good financial strategy.
The copay, is how much you pay for every doctor visit. Every time. The deductible, is how much you pay, every year, before the insurance starts paying. The coinsurance, is how much of every claim you pay, AFTER you've paid the whole deductible amount. As an example, if you have a $10,000 deductible, and have a $5,000 operation - you pay the whole $5000. If you have an 80/20 coinsurance, and have a $20,000 operation, you pay the first $10,000 (deductible) and 20% of the second $10,000, or $2,000. There's ALSO going to be a maximum out of pocket amount - the most you'd have to pay, no matter HOW high the bills go. Keep in mind, many times that office visit is OUTSIDE of the deductible - but any testing you'd have done, is INSIDE the deductible. I'd strongly suggest that since you're a bit fuzzy on terms, "do it yourself" health insurance isn't a very good idea. Use a local broker. It won't cost you any more, and they'll be able to explain ALL the options, BEFORE you buy it. Waiting until AFTER you've got $50,000 in unpaid medical bills, to learn about WHY they weren't covered - isn't a very good financial strategy.
