What is My Deductible?
Your deductible is the amount you pay before the insurance starts paying. If you have a 5000 dollar deductible, and you get in a car wreck, you would pay the first 5000, then insurance would start paying.
What is Coinsurance?
Coinsurance is what kicks in after you have met your deductible. If you have coinsurance, this means that after you meet your deductible, you’ll start splitting bills with the insurance companies. Common splits are you paying either 20% or 50%.
What is a Stop-loss?
The stop loss is the third piece of the puzzle. After you have met your deductible, you’ll start splitting bills with the insurance company. This will continue until you have reached your stop-loss. Average stop-losses range from 1,000-10,000 dollars.
Total out-of-pocket risk?
Total out of pocket is when worse comes to worst. You get in that major catastrophe- a $100,000 medical bill has been racked up.
Your coverage is:
- 5,000 deductible
- 80/20 Coinsurance
- 3,000 Stop-loss
You will pay-
- Your deductible-($5,000) Leaving $95,000 left to pay
- You then split bills with the insurance company- (you pay 20%)
- As soon as you hit $3,000 while paying 20% you are done paying. Leaving- 80,000 left to pay.
- Since you have reached your stop-loss insurance pays 100% of remaining costs.
Your total out of pocket? $8,000
What is a Co-pay?
A co-pay is a Set amount that you pay every time you visit a doctor or specialist.
These range anywhere from $15-50. You pay more for your insurance each month, but you save each time you go to the doctor. You can determine this value by looking at how much more it costs to get co-pays and how many times you usually go to the doctor in a year.
What is Major Medical coverage?
What we just described is major medical coverage. Major medical will cover all expenses after you have satisfied a deductible and coinsurance stop-loss. Major Medical is appropriately named, as it is intended to cover your major medical expenses.