What Am I Responsible For?

You are responsible for all charges that your insurances does not cover, such as copays and deductibles, and you will be billed out of pocket for anything your insurance does not cover. While we do our best to help, you are ultimately responsible for knowing your own insurance plan and understanding it.

 

What is a Deductible?

A deductible is an amount that must be paid for covered healthcare services before insurance begins to pay.  This means, for example, that if you have a deductible of $5,000, you must pay $5,000 out of your own pocket before your insurance will begin paying. High deductible plans usually have a lower monthly premium, so when choosing insurances, take the time to consider which opt

 

What is a Maximum Out-Of-Pocket?

This is the maximum amount of your own money you will have to pay for care during the year.  Think of the out-of-pocket limit as your deductible + coinsurance + copayments. The only costs that don’t count toward your out-of-pocket limit are premiums, which you must continue paying to maintain your coverage. Per the Affordable Care Act (ACA), no health plan sold on the Health Insurance Marketplace for 2020 can have an out-of-pocket limit in excess of $8,150 for an individual or $16,300 for a family.[i]

 

What is an HSA?

An HSA is a tax-advantaged Health Savings Account that is created for people who get their insurance coverage through high-deductible health plans (HDHPs). Regular contributions to the account are made by the employee or employer and can be used to pay for qualified medical expenses that are not covered by the HDHPs. The contributions can be used to pay for medical, dental, and vision care as well as prescription drugs.[ii]

 

What is a Copay?

A copay is a fixed out-of-pocket amount paid by an insured for covered services. It is a standard part of many health insurance plans. Insurance providers often charge co-pays for services such as doctor visits or prescription drugs. Copays are a specified dollar amount rather than a percentage of the bill, and they usually paid at the time of service. Not all medical services ask you for a copay. For example, some insurance companies do not require a copay for annual physicals.[iii]

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What is Co-Insurance?

Coinsurance is the percentage of your medical costs that you actually have to pay after reaching your deductible. When you incur health care costs from a medical procedure, you have to pay out of pocket until you spend a certain amount, known as your deductible. Once you hit your deductible, your insurance company starts splitting the cost of future care, based on a set percentage of the costs. The percentage that you pay is your coinsurance.[iv]

 

 

Sources and Further Reading

 

[i] HealthMarkets. “Deductible vs. Out-of-Pocket Limit: What’s the Difference?” https://www.healthmarkets.com/resources/health-insurance/deductible-vs-pocket-limit-whats-difference/. Accessed August 11, 2021.

 

[ii] Kagan. Investopedia. “Health Savings Account (HSA)” http://www.investopedia.com/terms/h/hsa.asp. Accessed August 11, 2021.

 

[iii] Kagan. Investopedia. “Copay” ttps://www.investopedia.com/terms/c/copay.asp. Accessed August 11, 2021

 

[iv] Silva. Policygenius. “What is coinsurance?” ttps://www.policygenius.com/health-insurance/what-is-coinsurance/. Accessed August 11, 2021.