• Broadway Physical Therapy

Premiums, Deductibles & Copay's - How it all works!

Updated: Feb 12, 2019



 With new day Health Insurance becoming more costly and employers choosing lower cost options many are wondering what insurance terms such as:Deductible,Copay, Coinsurance, and Premium mean. In this post we will go over these to help give you a better understanding of these terms.

What is the Difference? Copay- A copay is a predetermined amount from your health insurance that you pay for various health services. This rate can vary depending on who you are seeing. For Example: you could have a $25 copay for your primary care physician , $35 for a specialist and $100 for emergency room visits. 

Premiums- This is a monthly amount paid to the Health Insurance to make sure you have Health Insurance coverage. If you have Health Insurance through an employer some or all of the premium cost may be covered. 

Deductible- This amount varies depending on who and what your Health Plan is. A Deductible is the amount of money you have to pay before the Health Insurance Carrier starts to cover your bills. For Example: If you have a $500 deductible the first $500 in bills will be paid directly from you and not the Health Insurance. Most deductibles reset on a yearly basis.

Coinsurance- Some Health plans include a Coinsurance which is a percentage that you are responsible for. Most of the time a Coinsurance is applied once the deductible has been met. For Example: Lets say you have met your Deductible and your plan has a 20% coinsurance, any bills after the Deductible has been met you are responsible for 20% of cost and your Health Insurance Carrier covers the other 80%. 

How Can I Determine the Cost?   When trying to Determine how much you will be responsible it is important to call your Health Insurance carrier before seeking Health Care Services. For Example: Lets say you have a $500 Deductible, with a 20% coinsurance once Deductible has been met. You go to see your doctor who bills your Health Insurance $150(just an estimate), you will be responsible for 20% of that $150 which is $30. So for that MD visit you would be responsible for $30.



In Conclusion:  When seeking Health Care services always help yourself by knowing your plan. This ensures that you will know the cost upfront and have a better understanding of what to Expect Financially. If after reading this article you have questions regarding your plan it is always best to call your Health Insurance Carrier.

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