What is “Co-Insurance”???
Re-posted on 5/9/18
Co-insurance means 2 parties will be paying for the bill. “Co” means joint, mutual, 2 or more. The insurance company will usually pay the larger amount (example 70%) and you the member will usually pay the lesser amount (example 30%). This would be a co-insurance 70/30. This (co-insurance) usually happens AFTER the deductible.
A “deductible“ is an amount you pay before the Insurance Company starts paying (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 of 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 have to pay in a year, not the insurance company. Once you’ve met your “out of pocket maximum”, you are now done paying anything else. The insurance company will pick you up on 3rd base, and carry you to home plate.
Note: This is an annual accrual, meaning it starts January 1st and ends December 31st each year.