medical monday, theme days

Medical Mondays: coinsurance, copay, and other confusing insurance technobabble

With the new insurance year almost in full swing, let’s review some important insurance terminology.

Coinsurance and copayment – what in the world is the difference?

Okay, so a copayment is a portion of money you have to pay your doctors, etc, for services rendered or to your pharmacy for a prescription. Copays are generally a fixed rate – for example, Lyrica through my current pharmacy is $20 a month.

Copays also usually go away if you hit the out-of-pocket maximum for your plan. If you had an MRI in early January last year like me, that means you hit the maximum pretty quick and got to enjoy appointments without having to pay much in the rest of the year.

That came in handy with bronchitis and other BS, I tell you what

Bear with me, because coinsurance is not so straight forward.

The coinsurance is an extra amount you owe, which is generally the balance of your total medical bill once your insurance pays their part – regardless of whether or not you paid a copayment.

And then, there’s your deductible… which is basically the amount of money you have to pay before insurance will cover anything.

Copayments don’t count towards that amount because that would assume that the insurance is picking up any part of the tab.

If you’re chronically ill like me and end up having to see various providers a lot, you’ll likely want an insurance plan with a lower deductible because it’ll save you money up front.


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