Now that we have gotten through copays and deductibles, we must now consider co-insurance. After you satisfy your deductible then you have a portion, shared expenses with the insurance company. Co-insurance is where the plan pays a percentage of the cost and shares the other percentage with you. A few plans will pay 100%, but most look at 90% or 80% with you paying 10% or 20%.
These will be the percentages of the plan until you reach your out-of-pocket maximum, after which the plan pays at 100% for the remainder of that plan year. A few caveats to consider is some plans will still make you pay copays even after the out-of-pocket maximum is met. Co-insurance sounds like you the member are paying even more after paying premiums and deductibles, but the thing to consider is the rising cost of healthcare is making it harder to have all inclusive plans that don’t break the bank.
Next up will be in-network and out-of-network as well as coordination of benefits. All of these play important roles in all the terms we just covered.