- Some plans have an annual deductible, this is the amount you pay out of pocket before your health insurance begins to pay. Deductibles typically start over at the beginning of the new year.
Example: If your plan’s deductible is $1,500. You will pay 100 percent of your medical and pharmacy bills until the amount you’ve paid has reached $1,500. After that, you may share the cost with your plan by paying coinsurance and copays.
- Coinsurance is your share of the costs of a health care service. It’s usually figured as a percentage of the amount charged for the visit. You may start paying coinsurance after you’ve paid your plan’s deductible.
Example: You reach your $1,500 deductible, after reaching your deductible the insurance plan pays 70% of a visit. You’ll be responsible for the other 30% of the visit. If the visit costed $150, the insurance will pay $105 and the policy holder will pay $45.
- A copay is a fixed amount you pay for a health care service, paid when you receive the service. The amount can vary by the type of service. You may also have a copay when you get a prescription filled.
Example: The copay for an urgent care visit may cost $30.This varies between different plans. For some services, you may have both a copay and coinsurance.
Out-of-Network or In-Network
- In-Network: refers to providers who are contracted with an individual’s insurer to provide services at a pre-determined rate.
- Out-of-Network: refers to providers who are not directly contracted with an individual’s insurer. Out-of-Network coinsurances, copays and deductibles may differ from in-network costs. Not all insurances have out-of-network benefits, which means that you may be responsible for the bill.
Please use our eligibility checker on our website or ask our staff to assist you in answering any questions. We are here to help!