Another insurance question

[WolfpackMom]

I know coverage varies by provider. But can someone please give me an idiots guide to understanding co-insurance and deductibles and what it all means? I am reading through DS' crappy insurance plan ahead of his ear tube surgery.
Deductible $3500
Coinsurance Maximum $3000
Coverage 50% AFTER deductible

Does this mean that after we have hit $3500 in co-payments they will still only cover 50% of costs? I am confused by the dollar value on coinsurance, the plan says "Coinsruance is the sharing of charges by provider and member for covered services after you have satisfied your benefit period deductible."

What is coinsurance?

I have figured out for prescriptions that the copayment/coinsurance doesnt apply until we hit the $500 deductible which is why his asthma meds were so $$$.

Please help me be an adult....:banghead:

[vonfirmath]

Does this mean that after we have hit $3500 in co-payments they will still only cover 50% of costs? I am confused by the dollar value on coinsurance, the plan says "Coinsruance is the sharing of charges by provider and member for covered services after you have satisfied your benefit period deductible."

After you have paid $3500 in deductible, they will pay 50% of future bills.
Deductible is what you pay before they pay 1 penny of coverage. Coinsurance is the percentage they pay afterward.

The Coinsurance max MAY be the max you have to pay out of pocket as coinsurance after which they pick up 100% of the costs.

[Mermanaid]

Insurance can be so confusing! So, here's some crib notes on your plan.

1. Deductible - in most plans, this is the amount you have to pay before you and the plan begin to share expenses. HOWEVER, most plans don't include regular dr visits copays in this amount. So in your case with the surgery, you would have to pay the first $3,500 before the plan begins to cover anything.

2. Coinsurance maximum - after you meet the $3,500 deductible and the plan starts to share expenses with you, the most you will have to pay out of your pocket towards your coinsurance - which is the 50% the plan pays - is $3,000. Copays do not count towards your coinsurance maximum typically (I say that because plans can be set up differently).

So ultimately, the most you would have to pay out of your pocket (not including copayments for regular office visits, etc.) is $6,500 ($3,500 deductible + $3,000 coinsurance max).

HOpe that helps a bit.

[WolfpackMom]

Thank you, both of your responses do help a bit. For some reason this individual plan is a bit more confusing than my plan through work...its also appearing to be way more expensive.

Thanks!

[AnnieW625]

I know coverage varies by provider. But can someone please give me an idiots guide to understanding co-insurance and deductibles and what it all means? I am reading through DS' crappy insurance plan ahead of his ear tube surgery.
Deductible $3500
Coinsurance Maximum $3000
Coverage 50% AFTER deductible

Does this mean that after we have hit $3500 in co-payments they will still only cover 50% of costs? I am confused by the dollar value on coinsurance, the plan says "Coinsruance is the sharing of charges by provider and member for covered services after you have satisfied your benefit period deductible."

What is coinsurance?

I have figured out for prescriptions that the copayment/coinsurance doesnt apply until we hit the $500 deductible which is why his asthma meds were so $$$.

Please help me be an adult....:banghead:

It's all that stuff that makes me very happy that I have no problem with HMO insurance and have an excellent plan. Only benefits of PPOs with deductables that you can at least write the costs off on your taxes (we have never once had that option because our HMO covers everything, and monthly premiums are still less than the minimum dollar value needed to write off on taxes). :hug: to you. I don't get the stuff either.