Understanding Co-Insurance With a Health Plan
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.
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.
Getting Help From Nevada Insurance Enrollment
Navigating through the many options of insurance can be confusing and costly. However, speaking with a locally licensed insurance agent will help you to obtain the right coverage you need at a price you should be able to afford. You’ll have peace of mind knowing that you are properly insured when life complications arise. We work hard to find the most competitive quotes for your needs. Contact us today to begin the process of finding the best insurance plan for your family.
Recent Posts
Why Have PPO Plans Vanished from Nevada’s Individual Market?
The PPO plan decline reflects a Nevada health plan shift, with Nevada Health Link offering HMO/EPO plans due to ACA rules and record 2025 enrollment. These plans limit provider choices but ensure affordable coverage. Learn why PPO plan reduction occurred and how to choose coverage.
Health Insurance Benefits for American Indians
Health insurance for American Indians offers zero cost-sharing, monthly enrollment, and IHS access via Nevada Health Link. The ACA ensures affordable Nevada tribal health coverage with premium tax credits and Medicaid/CHIP options. Learn how to navigate tribal health insurance benefits.
What is a Summary of Benefits and Why Should I Read It?
A summary of benefits (SBC) is a 4-page document explaining a health insurance plan’s coverage, costs, and examples. It helps compare plans, understand costs like premiums and deductibles, and assess coverage for services like doctor visits or preventive care. Available through Nevada Health Link, the SBC is standardized for easy comparison but does not include provider networks or full exclusions. Learn how to use the SBC to choose a plan that fits your needs.
Search This Website
Most Popular Pages
By page visits (this month)
#1) Health Insurance Subsidy Chart
#2) Health Insurance
#3) Health Insurance WITH a Subsidy
#4) Insurance Blog
#5) Request a Quote
Top 5 Most Popular
By page visits (this month)
#1) Health Insurance Subsidy Chart
#2) Health Insurance
#3) Health Insurance WITH a Subsidy
#4) Insurance Blog Posts
#5) Request a Quote
Recent Posts
Health Insurance Benefits for American Indians
Health insurance for American Indians offers zero cost-sharing, monthly enrollment, and IHS access via Nevada Health Link. The ACA ensures affordable Nevada tribal health coverage with premium tax credits and Medicaid/CHIP options. Learn how to navigate tribal health insurance benefits.
What is a Summary of Benefits and Why Should I Read It?
A summary of benefits (SBC) is a 4-page document explaining a health insurance plan’s coverage, costs, and examples. It helps compare plans, understand costs like premiums and deductibles, and assess coverage for services like doctor visits or preventive care. Available through Nevada Health Link, the SBC is standardized for easy comparison but does not include provider networks or full exclusions. Learn how to use the SBC to choose a plan that fits your needs.
Nevada Insurance Requirements for Vehicle Registration
Confused about insurance requirements for vehicle registration in Nevada? Learn why auto insurance is mandatory, with minimum liability coverage of 25/50/20. Understand how to provide proof, navigate the registration process, and avoid costly lapses. From required documents to penalties, this guide covers it all. Discover optional coverages and cost-saving tips to stay protected.
What Is a Health Insurance Carrier?
A health insurance carrier provides plans to cover medical expenses, like doctor visits and prescription medications. Understanding your insurer’s network, plan types (HMO, PPO), and costs (premiums, deductibles) is key to choosing coverage. In Nevada, carriers collaborate with Nevada Health Link to offer ACA-compliant plans, ensuring access to preventive care and essential benefits. Learn how to select a dependable health insurance company and manage costs effectively.