Coinsurance is the percentage of medical costs a patient is responsible for paying after they have met their health insurance deductible. Unlike a copay, which is a fixed amount, coinsurance is calculated as a percentage of the total cost of a covered service.
For example, if a patient has a health insurance plan with 80/20 coinsurance, it means the insurance covers 80% of the medical costs, and the patient is responsible for the remaining 20%.
How You Can Use Coinsurance for Your Orthopedic Visits:
Meet the Deductible: Before coinsurance kicks in, you must meet your annual deductible. For example, if the deductible is $1,000, you must pay that amount out-of-pocket first.
Apply Coinsurance to Remaining Costs: After the deductible is met, coinsurance applies to eligible orthopedic services. For instance, if an MRI costs $2,000 and the plan covers 80%, your insurance will pay $1,600, and you will pay $400.
Out-of-Pocket Maximum: Once you’ve reached your out-of-pocket maximum (including deductible, coinsurance, and copays), the insurance company typically will cover 100% of any additional covered expenses for the remainder of the policy year.
Tips for using your Coinsurance:
Verify Coverage: Check with your insurance provider to understand what orthopedic services are covered and at what coinsurance rate.
Use In-Network Providers: Coinsurance rates are typically lower when using in-network orthopedic specialists.
Budget for Costs: Be prepared for out-of-pocket expenses by knowing your deductible and coinsurance percentages upfront as determined by your selected insurance provider
- How to Contact Your Insurance Provider: on the back of your insurance card, there should be a contact number that you can call and confirm your selected insurance benefits and terms.
Please contact your insurance provider to confirm your selected insurance benefits including coinsurance, copay, and additional coverage terms.