What are Deductibles, Copays and Coinsurance?
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What is a deductible?
Every health insurance plan has a deductible. This is the amount you pay for medical care before the plan starts covering your medical bills. Say your deductible is $1,000. You pay your medical bills up to $1,000 before the plan starts paying a portion of your medical costs. You may still have to pay a portion of your health care after reaching your deductible. This comes in the form of copays and coinsurance.
The deductible is specific to your health insurance plan. Your plan might have separate deductibles for in-network and out-of-network services. The out-of-network deductible might be higher than the in-network deductible.
Family insurance plans often have individual and family deductibles. Each person has to reach the individual amount before the plan pays for their care. As soon as your family deductible is met, your plan starts paying the coinsurance amount for everyone's care. That's the case even if some family members haven't met their individual deductible.
What is a copay?
A copay, also called a copayment, is a set amount you pay for a health care service. An example is a $25 copay for a regular doctor visit. You pay the $25 copay each time you visit the doctor. The payment is usually due at your appointment. Many health insurance plans have different copays for different services. The copayment might be different for:
- Doctor's visits
- Urgent care visits
- Specialist visits
- Emergency room visits
- Medical imaging
- Prescription drugs
- Tests and screenings
Not all health insurance plans have copays. The copay amount is specific to your plan and each specific service you receive. The money you pay for copayments doesn't count toward your deductible.
What is coinsurance?
Coinsurance is similar to a copayment. It's the amount of a medical bill you pay. Instead of a set amount, it's a percentage of the medical bill. Say your coinsurance is 20%. Your medical bill is $1,000. You pay $200 of the bill. Your health insurance pays the other $800. You pay your coinsurance amount after you reach your deductible
How do deductibles, copays and coinsurance work?
The amount you pay for a health care service depends on the details of your plan. If you have copays, you pay that amount when you receive the service. Some services might not have copay amounts. You pay the full amount for the service if it doesn't have a copay until you reach your deductible.
You pay the coinsurance amount for services after you reach your deductible. You continue paying copays and coinsurance until you reach your out-of-pocket maximum. This is the maximum you have to pay for the year. Your insurance plan pays all of your medical bills for covered services after you reach the out-of-pocket maximum.
Your payment amount can be higher if you visit an out-of-network provider. The standard deductible, copay and coinsurance apply to in-network providers. These are the healthcare providers who accept your plan. They have lower negotiated rates with the company. If you go to an out-of-network provider, you might have to pay the entire bill. The amount will likely be higher because it's not the lower negotiated rate. Some insurance plans don't cover out-of-network care at all. Plans that do cover it often pay less. That leaves you to pay a larger portion of the bill. Check with your insurance plan to determine whether providers are in-network.
Can I use my health insurance at MinuteClinic?
MinuteClinic accepts most health insurance plans. This includes:
You can check your insurance before you schedule an appointment. This lets you confirm that your insurance plan will cover your MinuteClinic visit. MinuteClinic offers affordable pricing even if you don't have health insurance coverage to use. You can pay with a debit, credit, FSA or HSA card to cover the out-of-pocket costs. Patients can also use Medicare and Medicaid at MinuteClinic for in-person care only.
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