How Confusing A Copay and Coinsurance Can Cost You

Copay and coinsurance

“What’s the difference between a copay and coinsurance?”

This is a question our benefits department receives quite often. For most it can be quite confusing. The short simple answer is a copay is usually a set dollar amount and coinsurance is a percentage of the cost. Let me explain.

Copay

Copay’s or copayment’s are fixed dollar amounts you pay for covered health care. These are usually charged when you receive the service. For example you pay a set $20 when you visit your primary care doctor. 

Coinsurance

Coinsurance is your share of the costs of a covered service. It is calculated as a percent of the allowed amount for the service. For example, if the plans allowed amount for an overnight hospital stay is $1,000, your coinsurance payment of 20% would be $200. This may change if you haven’t met your deductible. 

The below image from a Summary of Benefits and Coverage shows you example of the listings for copay and coinsurance. 

Copay and coinsurance

How Will Confusing Copay and Coinsurance Cost Me?

Depending on your plan, you could find yourself in a situation where you pay extra money because you choose the wrong type of provider. Say your plan has a $100 copay for a Urgent Care visit but if you go to the Emergency Room your plan has a 20% coinsurance cost. You just have strep throat and not a life threatening situation. The Urgent Care will cost you $100 but the Emergency room will be 20% of the total cost. I don’t know if you’ve been to the Emergency Room lately but most of the times just to walk in is about $1000! That alone has you at $200 ($1000 x 20% = $200). Just by choosing a different type of facility you overspent. But by understanding your benefits can help. (The above are strictly fictional numbers, but you get the idea). 

Health Insurance can be confusing especially if your new to handling your own coverage or have never taken the time to read up on the definitions. Copay and coinsurance are just the tip of the iceberg so to speak. But don’t fret, we are available to answer any questions you may have. Give our benefits department a call today with any questions you may have. 

You can also view the below blog post that goes into more detail on other health insurance benefit definitions. 

Do You Understand The Insurance Benefits Offered By Employers?

What All Newlyweds Need To Know About Insurance

newlyweds

newlywedsChoosing insurance may not be as romantic as deciding where to go on your honeymoon, but it is one of the most important things you can do as newlyweds. Although most couples are aware of the need to readdress their insurance needs when they get married, there is a disconnect between that awareness and whether they take action.

Use the considerations in this article as a way to start a discussion about your insurance needs. Rinehart, Walters & Danner can then help you narrow down your options.

Auto Insurance

If you and your spouse have separate auto insurance policies, it may be wise to combine them. Get quotes from each of your carriers, and shop around to see if any others offer multivehicle discounts.

Life Insurance

Newlyweds who both have jobs and are not yet dependent on their spouse’s income may not see the need for life insurance. However, as they build their lives together, that dependency grows. If you’re young and healthy, you can benefit from getting life insurance early in your marriage. Typically, you can lock in better rates than if you were older. Remember that the older you get, the higher the rates, so don’t put it off for too long.

While life insurance is less urgent for young couples who are both working and don’t have children, it is important for newlyweds with only one working spouse or those who have children from a previous marriage to purchase life insurance early in their marriage.

If you already had life insurance prior to tying the knot, don’t forget to add your new spouse as a beneficiary.

Disability Insurance

Young people are more likely to become disabled than die prematurely. In fact, more than half of Americans identified as disabled are in their working years—between ages 18 and 64— according to the Council for Disability Awareness.

Disability insurance is historically inexpensive, and can pay you between 50%-70% of your regular monthly income if an accident, illness or injury prevents you from being able to work. If your employer doesn’t offer disability insurance, you can purchase it on your own. This coverage can be critical for you and your loved ones.

Health Insurance

Don’t make the mistake of declining health insurance, even if you and your spouse are healthy. An illness or emergency can cause newlyweds financial hardship that could have been prevented with health insurance. If you and your spouse both have health insurance through your employers, you can maintain separate plans, but it may be cheaper to be on the same plan. Doing so can help you reach your annual deductible more quickly.

Certain life events, such as marriage, allow you to join your spouse’s plan as long as it is within the required time frame. If you decide to share a plan, compare both employers’ coverage and costs to determine which plan best fits your health needs and finances. Be sure to consider each plan’s deductibles, coinsurance, copayments, coverage limits, prescription coverage and choice of health care providers. Remember that if you have a preferred doctor, you’ll want to make sure he or she is in your network.

Don’t panic if employer-sponsored health insurance is not an option for you. Coverage is available to everyone through the Affordable Care Act. You can visit http://www.HealthCare.gov to review and select a plan through the health insurance marketplace, either during open enrollment or within 60 days of getting married. Or, you can contact one of our health insurance specialist and they can assist you with this process. Timing is restrictive so it is important you check into this promptly. 

Renters Insurance

If you rent your living space, you should consider renters insurance to cover the value of your possessions. If you already have renters insurance, don’t forget that you have more to lose now that you have combined belongings, such as furniture, electronics and jewelry. Consider increasing your limits on personal property coverage, which pays to replace or repair items that are stolen or damaged.

Homeowners Insurance

Homeowners insurance is similar to renters insurance, but it covers more than just your possessions. It also covers your home in case of fire, theft or other perils. Both renters insurance and homeowners insurance also provide liability coverage.

Shop Around for Coverage

Addressing your insurance needs early provides a solid foundation for your marriage. Review your financial situation and objectives with your spouse. Then contact Rinehart, Walters & Danner to help you find sufficient coverage within your budget.