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 Posted: Fri Dec 05, 2008 7:01 pm Post subject: what does no coinsurance mean |
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| if the annual deductable is $1500 and the services provided say no coinsurance, does that mean the employee pays 100% of everythign every time they go to the dr? |
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pmcgill
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| Posted: Fri Dec 05, 2008 8:29 pm Post subject: |
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It means the insured is responsible for the first $1500 of bills (deductible) and after that, the insurance company pays 100%.
I think a health policy like this is unusual these days. Usually if there is a deductible, there is a co-insurance amount (usually 80%). However, preventive treatment is usually paid at 100% with no deductible on this type of plan. |
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tcope
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| Posted: Sat Dec 06, 2008 8:56 am Post subject: |
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Yup, in health insurance no-coinsurance plan may mean that you are not required to pay any out-of-pocket expense (apart from the said deductible) at the time of need. Normally, these plans charge higher premium than policies with deductibles and co-insurance.
Paying high on such policy may worth if you're in bad health, require constant treatments or are suffering from chronic health problem. It would reduce your out-of-pocket expense. However, if you are of good health, it'd be wise for you to save on the premium by buying a plan with deductible and co-insurance. |
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JeremyHolter
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| Posted: Sat Dec 06, 2008 9:17 am Post subject: |
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| Quote: | | Usually if there is a deductible, there is a co-insurance amount (usually 80%). |
I have heard of no deductible and no-coinsurance plans, but with deductible but no-coinsurance, not that I'm aware of.
Pmcgill, who have told you about this type of policy? And how much you are required to pay for it?
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anonymous-guardian
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| Posted: Sat Dec 06, 2008 3:02 pm Post subject: insurance |
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Health Insurance: It's just getting to the point that NO ONE will beable to afford it. Like everything else, the 'price' of it is just SKYROCKETING!!! Absolutely horrible.  |
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sdchargersfan
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| Posted: Mon Dec 08, 2008 9:08 am Post subject: |
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You are absolutely right SD, the prices of health insurance have beaten the rise in wages and therefore many people were forced to drop their health coverage. Many employers too have decided to abandon the policy of offering group health plans because of the price rise. Small business houses are finding it gradually difficult to offer the benefit of heath policy to their employees. All these are again contributing to the growing population of the uninsured. The situation is grave no doubt  |
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JeremyHolter
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| Posted: Mon Dec 08, 2008 9:30 am Post subject: |
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Well friends, in this trying situation it has become even more necessary to make a wise choice with the health plans to retain the cost of policy within your budget. The following steps can be performed in order to make a well informed decision regarding purchasing the private health plans..
- Draw a budget for the health plans to know how much you can actually afford, and shop around for plans.
- Its better to work with an independent insurance agent or a broker. They can offer you more choices since they don't work for any particular health insurer. They may also help you in comparing the insurance rates and verbiage of the policies.
- Check out with the state's insurance rules, especially the clauses associated with the pre-existing condition. Preventive care and immunization are normally covered under the plans.
- understand the differences between the words HMO, PPO and HSA since these different options will also affect your health insurance costs.
Health care reform has remained a topic of debate and discussion during the presidential election, may be we will soon experience changes in the health care system but till that time we need to do our best to keep the costs at control. |
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jeorge
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| Posted: Tue Dec 09, 2008 7:24 am Post subject: insurance |
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| Hopefully ..the issue, of Health Care costs will change with our new president. GOD KNOWS, the last one din't seem to 'address' the issue of people having NO Health Care and what to do if you DON"T have it..ya know? |
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sdchargersfan
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| Posted: Fri Apr 30, 2010 1:29 am Post subject: what to ask the broker/agent |
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I myself am an agent of MetLife for the last year. I am learning the health insurance business while i am here. I will tell you when you speak with an agent, question him on what he knows (can he/she explain the verbiage to you?) I see plenty of managers pressuring the agents to get in the business door with health insurance because it is such an issue; these people do it blindly. There are good agents/brokers out there who focus on the health insurace, and can shop you around. Look to be a client, not a custumer. Also, its not selling, its advising. Answer the questions the agent/broker ask you so they can give you the proper guidance
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Checkitout
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| Posted: Fri Apr 30, 2010 3:14 pm Post subject: |
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| Quote: | | when you speak with an agent, question him on what he knows |
Always excellent advice. And not only with health insurance. Too many agents sell products without knowing how they work, what they do and do not cover. They inadvertently pass on misinformation to their clients, exposing the clients to potentially devastating losses.
Don't be afraid to ask an agent, "So, how long have you been in the business?" Some of us can respond by saying things like, "I was first licensed as a life agent in 1980, and I added my fire & casualty agent's license in 1998." But even 20-30 years in the business doesn't guarantee that an agent is truly knowledgeable.
You may have to ask, "Tell me how this works -- in a way that I can understand it," if what the agent said to you sounded more like, "Blah, blah, blah, blah-bitty blah." If the agent has a good understanding of his product(s), he or she will easily be able to do that (and probably did, eliminating the need for that questions).
| Quote: | | its not selling, its advising |
Also very true.
I take my role as an agent to mean I am an educator first. I teach my clients to recognize their needs, then I educate them in the products that are available to meet those needs, and how those products work, and then, after thoroughly analyzing their present situation, I present the products I believe are most closely suited to meet those needs at the best price.
If I've educated the client properly, there is no objection to my final request: "So make out your check, not to me, but to [insert name of insurance company here], and we'll see if you qualify." I can't remember the last time a client said, "You mean I have to give you a check tonight?" Because I have already explained that their coverage cannot go into effect until the company receives their first payment, and that their coverage will not start sooner than when they are approved (at least for any of the disability/health insurance products -- it's a little different for life insurance, or for auto and homeowner's).
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MaxHerr
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| Posted: Sat May 01, 2010 8:03 am Post subject: |
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| Quote: | | Too many agents sell products without knowing how they work, what they do and do not cover. |
This is one of the major obstacles towards the growth of an agent. This way, the customers would also suffer in the long run.
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Juanita
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| Posted: Sun Aug 01, 2010 2:14 am Post subject: Coinsurance |
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If the deductiable has been met, how do you figure the cost the patient pays and the cost the payer will be reimbursed.
Patient has a $250 deductiable and 80/20% coinsurance.
the usual charge is $202 and the health plan allowed charge is $176. I am so confused.
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beatrice
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| Posted: Sun Aug 01, 2010 2:42 am Post subject: |
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| Quote: | | Patient has a $250 deductiable and 80/20% coinsurance. the usual charge is $202 and the health plan allowed charge is $176. I am so confused. |
Your confusion is noted. Chalk it up to insurance companies beating up on providers to accept less than their customary fee.
Assuming the $250 deductible has already been met (100% out of pocket expense for the insured), if the coinsurance is 80/20, this means the insurer will pay 80% of the "covered" expenses and the insured will pay the remaining 20%.
If the insurer establishes a limit of what it believes is "usual and customary" or "usual, customary, and reasonable", it pays 80% of that amount, and the insured pays the balance, which could be more than 20% of the total bill.
However, in an HMO or PPO plan, the insurer usually negotiates provider charges it believes is "allowable". The physician bills their usual fee (to establish that it is so that other patients can be billed the same amount). If the insurance company allows a lesser amount, the physician agrees to limit their bill to that amount, and the insurer and the patient share the allowable amount 80/20.
The insurer usually sends out an "Explanation of Benefits" that shows "Patient Savings" of the disallowed amount. It could be labeled "Insurance Company Profit".
Hope this helps clear the confusion.
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MaxHerr
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| Posted: Mon Nov 01, 2010 1:51 pm Post subject: Short Term Plans |
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I am shopping around for affordable insurance . If a plan has a $500 deductible,the coinsurance is 80/20. This portion I understand. But this plan also includes $2,000 Coinsurance Out of Pocket Maximum after deductible. Does this mean that after I meet my deductible I will be responible for 20% of my medical expenses along with an additional $2,000 deductible ?
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123short
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| Posted: Wed Nov 03, 2010 1:33 am Post subject: |
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Not exactly. Your out of pocket expense is 20% of your medical bills, up to $2,000 (in addition to your $500 deductible, total OOP = $2,500 per year). $2000 = 20% of $10,000. So your total medical bills for the year would have to exceed $10,500 before your insurance pays 100%.
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California-licensed Property & Casualty Broker-Agent and Life & Health Agent. CA Insurance License #0596197. Send me your questions, and I'll send you my answers. I live, breathe, and teach insurance! |
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MaxHerr
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