- Health insurance copay after deductible plus#
- Health insurance copay after deductible free#
My experience with US insurance companies and emergency rooms in the last few years has been as follows. You may find plans with noĬo-insurance requirements, some with 20/80 or 50/50 coinsurance, or
Health insurance copay after deductible plus#
$1,000 in services, you’ll pay the $100 plus 30% of the remaining If your plan has a $100 deductible and 30% co-insurance and you use
Deductible: $0 because you already met it +. If you've already met your deductible, then step 2 is $0 so it looks like this: So if your bill was $2000, you had a $100 copay, a $1000 deductible, and 40% coinsurance and you hadn't used any medical care you'd owe: What they are saying is that the copay comes first, then the deductible, then coinsurance. It would have been more accurate if the insurance company had said, "$100 Copay for first visit/40% Coinsurance after deductible for successive visits." Should I see if they're hiring copy editors? Turns out the phrase "$100 Copay before deductible/40% Coinsurance after deductible" really doesn't make any sense. This stops once I've hit my my maximum out-of-pocket limit, but by the time I've hit that limit, I've been responsible for quite a lot. Even after meeting the deductible, the insurance company only pays 60% of the cost, leaving the remaining 40% of the cost at my doorstep. ER trips at all until I meet the deductible. So now the insurance company doesn't cover the second, third, etc. Some people use the ER as their primary care provider. This is either really bad luck or really bad personal management. Stuff happens let's hope it doesn't happen again any time soon.īut now say I need to go to the ER a second time during my coverage period, or a third, or a fourth, or a fifth. The insurance company makes me responsible for a $100 copay for this first trip during my coverage period. Oh, well, sometimes that can't be avoided. Yes, this is an unusual case where my responsibility is smaller before meeting the deductible than after. I spoke to someone at the relevant insurance company. (The language "before deductible," though accurately transcribed, is misleading.) After that, ER trips start costing real money. Health insurance copay after deductible free#
Summary: The first ER trip is free (well, cheap). $740 is 30% of $2,466.67 I don't see where that number comes from. (I have no idea how a plan with a $100 copay ends up in this example with a $20 copay. (Added later) (but turns out to be irrelevant) Here are examples of how a similar plan ("$100 Copay before deductible/30% Coinsurance after deductible") works, using the two standard coverage examples: It makes no sense to me that my responsibility would be smaller before I met my deductible than after. If I have met my deductible (but not my maximum out-of-picket), I'm responsible for 40% * $2000 = $800.If I haven't met my deductible, I'm responsible for a $100 copay.
If I haven't yet met the deductible, I'd be responsible for all $2000.When coverage is described relative to a deductible, I presume I'm responsible for 100% until I hit the deductible.
$100 Copay before deductible/40% Coinsurance after deductible (U.S., federal exchange, I'll be losing COBRA which is a qualifying life event.) One of the plans describes its emergency room costs as:
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