Coinsurance took a back seat to co-payments for a long time, but it looks like a shift is going on that promises to cost consumers more money, the resurrection of co-insurance oftentimes replacing or in conjunction with co-payments.
Co-insurance is expressed as a percentage of the cost that you pay, and sometimes is in addition to co-payments, a flat fee you pay for a product or service. If you’re paying a percentage of a charge then you need to know what you’re being charged AND the percentage that your policy covers. It’s the tradeoff we didn’t know about when we were sold on Obamacare, sacrificing the sick in order to provide “free” preventive services.
At what stage should you consider co-insurance? Go through insurance steps:
1->Choose insurance coverage
2Pay premiums
3-> Get your Obamacare checkups
4->Need medical care
Find Participating provider
5->Call your health insurer and find out what you pay out-of-pocket for service
6->Pay out-of-pocket your share of fee
1->When choosing your insurance make sure you pay attention to co-insurance percentages, the charges for various services and products and compare that to other plans.
Example: You take medication for a condition. You’re accustomed to a $10 co-pay for medications but this year your plan changed and you pay 20 percent of the cost of the medication. If your medication is $100 from participating providers on your plan, you’ll pay $20 for that medication with a 20 percent co-insurance every time you get the prescription filled (up to a plan maximum if there is one).
If you use a pharmacy that is out-of-network, you’ll likely pay more than double that amount since your co-insurance might be as high as 45 percent of the FULL price, not the negotiated price that participating providers use. If you don’t try a generic option, if such an option is available, many plans will cover NOTHING. This is generic step therapy requiring you to try the generic before you can use a name-brand.
3-> Get your Obamacare checkup but beware of the shift from preventive to diagnostic. While preventive exams and tests are “free,” the minute you are or might be sick and you visit a doctor it will cost you money. Co-insurance means that you’ll pay out-of-pocket a percentage of every visit, test and action your doctor takes even if it’s part of your “free” preventive checkup if your doctor decides to look further into something.
Example: You go to the doctor for your “freebie” checkup. The doctor wants to check something out. He orders lab tests as an aid to diagnosis. Your shift from preventive to diagnostic means that even though your checkup is “free” your lab tests will cost you.
If your plan has a 20 percent co-insurance for lab tests, then that’s what you pay. If your plan has a 30 percent co-insurance for diagnostic lab tests, that’s what you’ll pay. Hopefully, you won’t have anything that requires more medical treatment, but those diagnostic tests will run you hundreds at the very least.
4->If you need medical treatment and care, in other words, you’re not well, the only reason anyone really needs insurance, to cover those unexpected and undetermined medical costs of getting well, then it’s going to cost you more.
You’ll have to check on the prices charged by various facilities and providers for the care you need, from lab costs to medical costs to physician costs since each of these parties have a contract with your insurance company and prices can vary. You can call providers and ask for the price and verify all information with your insurance company.
Example: For instance, if you need to find a specialist, their prices can vary significantly. Call your insurer and find out who participates in your plan and call those providers and ask about their prices.
Once you’re paying a percentage of the fee (co-insurance) rather than a flat rate (co-payment), you need to know what you’re being charged a percentage of. If one doctor charges $150 for an office visit and another charges $200 for an office visit and you’re liable for 20 percent of the fee, your charge will be either $30 or $40 for that office visit. It may not seem like much but you’re paying 25 percent more for the $200 office visit.
5->Never hesitate to call your insurer with your questions. It’s a good idea to document the call and its content in some way such as by sending a confirming email to your insurer.
6->You are responsible for your medical co-insurance bills. Do not ignore them but verify any amounts that either surprise you or that you believe are incorrect.
TIPS: Co-insurance can be treated differently by different plans. First, you’ll want to compare how much co-insurance you’ll be paying. If it’s 30 percent or 20 percent, this is the amount you’ll be paying each time you use a specific service. A $100 bill from your provider, and you’ll be responsible for $20 of every $100 if you have 20 percent co-insurance, $30 if you have 30 percent co-insurance.
There are usually limits to how much maximum you’ll pay in co-insurance, if nothing else, the out-of-pocket maximum for the year will kick in at some point. Often the amounts paid in co-insurance also contribute towards your deductible. Check your plan.
