What Is Co-Insurance?
Co-insurance means two parties will be paying for the bill. “Co” means joint, mutual, two, or more. The health insurance company will usually pay the larger amount (example 70%) and you as the member will usually pay the lesser amount (example 30%). This would be considered co-insurance 70/30. This (co-insurance) usually happens AFTER the deductible is met.
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A “deductible” is an amount you pay before the insurance company starts paying. Insurance plans will have different “deductibles” $250, $500, $2,000 etc., so read your plan. Think of it like 1st base in a game of baseball. Once you’ve paid all your deductible, you are standing on 1st base. Now you’ll begin to move towards 2nd base – “Co-insurance”. During this time, co-insurance is where you and the insurance company split the medical bills, for example 70/30 or 80/20. Usually, the insurance company will pay the larger amount and you pay the lesser amount.
Your next step is 3rd base or your “Out of Pocket Maximum”. This is the maximum YOU will pay in a year, not the insurance company. Once you’ve met your “out of pocket maximum”, you will no longer have to pay for any future medical services. This also includes the cost of prescription drugs. The insurance company will then pick you up on 3rd base, and carry you to home plate, meaning, the insurance company covers the rest of the bill, no matter how high it is.
Note: This is an annual accrual, meaning it starts over every January 1st and ends December 31st each year.
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