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 Posted: Wed Aug 27, 2008 9:12 am Post subject: Co-insurance and deductible: How do they work in a policy? |
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| I was wondering whether its coinsurance after deductible or is it the whole insurance claim..Say I have a deductible of 500$ and a 70/30 coinsurance policy .When does the coinsurance come into play?After I pay the 500$ deductible or for the whole sum of the insurance claim? |
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renditioner
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| Posted: Wed Aug 27, 2008 9:40 am Post subject: coinsurance deductible |
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The deductible comes off of your part if it's 70% then the deductible comes off that...(on all co-insurance claims I've worked anyway).
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Lori
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| Posted: Wed Aug 27, 2008 2:11 pm Post subject: deductible and coinsurance |
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Hi dear..suppose you have a claim amount worth $ X with a deductible worth $500 & a Co-insurance of 70/30, over here you're all set to pay {(500 + 30% of (X-500)}.
I say this because co-insurance is calculated as the % of allowed expenses once the deductible is paid up. That's why I say you avail coinsurance after deductible is paid. Fatman |
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fatman
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| Posted: Thu Aug 28, 2008 4:59 am Post subject: coinsurance deductible |
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I agree with what Fatman has said. Deductible needs to be paid before the insurance benefits kick in and it natural to have coinsurance after deductible. Its your must pay 'out-of-pocket' share and is determined in dollar terms.
Suppose, your insurer has promised to cover 80% of the medical expenses after you pay the deductibles. Hence, you should pay the deductible amount along with the remaining 20% of the costs.
Normally, the co-insurance is expressed as a percentage of the covered expenses.
Hope it clarifies 
~Jeremy |
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JeremyHolter
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| Posted: Thu Aug 28, 2008 7:06 am Post subject: coinsurance deductible |
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| So what is the use of deductible then ?If there is an agreement of sharing in co-insurance is it really necessary to have deductibles also in your policy? |
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renditioner
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| Posted: Fri Aug 29, 2008 8:38 pm Post subject: coinsurance and deductible |
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The deductible must be met before the insurer will pay anything. It's normal to have coinsurance after deductible. Covered expenses in excess of the deductible, in your case, will be paid @ the 70/30 co-insurance rate, up to any "stop-loss" limit that may apply in your policy.
To answer this question:
| Quote: | | So what is the use of deductible then ?If there is an agreement of sharing in co-insurance is it really necessary to have deductibles also in your policy? |
It's impossible to find a major-medical insurance plan that does not contain a deductible, and has been so for decades. HMOs generally have no deductible, they have "co-pays." PPO plans will commonly have deductibles which will vary with the plan. The purpose of a deductible in medical expense coverage is no different than those found in car insurance. They are primarily intended to eliminate small claims, and force the insured to retain part of the cost of the loss. You may be able to change the amount of the deductible, depending on whether it's a group or inidvidual plan. Just remember, the lower the deductible, the higher the premium costs will be.
With many plans, the deductible is waived for certain services, but applied to others. Hope this helps to understand the importance of coinsurance and deductible in some way...
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InsTeacher
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| Posted: Mon Sep 01, 2008 12:55 am Post subject: coinsurance deductible |
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| Some HSAs have no coinsurance after deductible has been met. |
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murph
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| Posted: Tue Sep 02, 2008 3:48 am Post subject: deductible and coinsurance |
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The purpose of the deductible is to reduce the costs the insurer has to pay.
It keeps people from over using their policies. It also shifts the smaller expenses to the insured and this means that the insurance company doesn't have to pay administrative people to handle the claims for the small stuff.
A zero deductible policy with no coinsurance would not be cost effective. It is more efficient to have the insured pay for the smaller stuff. There's nothing wrong with getting your coinsurance after deductible is met.
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