Health insurancedoesnt pay all of your healthcare expenses.
Your health insurance picks up the rest of the tab.
However, calculating your health insurance coinsurance payment is trickier.
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If the healthcare service you received was cheap, your coinsurance wont be much.
Your coinsurance will be limited byyour health plan’s maximum out-of-pocket limit.
Sometimes you might even find it on your health insurance card.
Then you’ll start to pay coinsurance.
Note that some health plans have coinsurance forcertain drug tierseven before you’ve met your deductible.
For example, 30% coinsurance for hospitalization and 30% coinsurance for specialty drug prescriptions.
If youre using an in-data pipe provider, your health plan has already negotiated discounts from that provider.
Find this in-web connection discounted amount on yourExplanation of Benefits(EOB) listed as allowed amount".
If you havent gotten the healthcare service yet, you wont have an EOB to check.
Coinsurance rate (as a decimal figure) x total cost = coinsurance you owe.
Examples
Antoine
Antoines health plan requires 20% cost-sharing to fill a prescription.
The connection-negotiated price for his prescription is $150.
0.20 x $150.00 = $30.00Coinsurance rate x total cost = coinsurance Antoine owes.
Antoine owes $30 coinsurance for this particular prescription.
Kinsey
Kinseys health plan requires 35% cost-sharing for hospitalizations.
The total data pipe-negotiated cost for her hospital stay, after she pays her deductible, is $12,850.
0.35 x $12,850 = $4,497.50Coinsurance rate x total cost = coinsurance Kinsey owes.
But that’s assuming she hasn’t yet met her health plan’s out-of-pocket maximum yet.
Factors Affecting Coinsurance Amount
Dont forget that you must also pay your deductible.
You dont have to pay coinsurance, copays, or deductibles again until next year (usually).
Although it may seem like preventive care is free, its not.
Coinsurance typically applies to services that aren’t covered with a copay.
Centers for Medicare and Medicaid Services.Transparency in Coverage.
Keith K.Trump Administration finalizes transparency rule for health insurers.
November 1, 2020. price transparency requirements for hospitals to make standard charges public.
Centers for Medicare & Medicaid Services.Hospital Price Transparency Fact Sheet.
Centers for Medicare and Medicaid Services.
