Understanding health insurance can be confusing, so Royalton Psychological Associates, LLC. has put together this explanation of insurance co-insurance.
What is co-insurance?
The percentage of costs of a covered health care service you pay (ex. 20%) after you have paid your deductible.
For example, your health insurance plan’s allowed amount for an office visit is $100 and your coinsurance is 20%.
• If you have paid your deductible: You pay 20% of $100, or $20. The insurance company pays the rest.
• If you have not met your deductible: You pay the full allowed amount of $100.
Is the amount owed the same with co-insurance?
No, the amount you will owe will vary until you have met your deductible. Typically, co-insurance plans will have you owing more at the start of the year, and the amount drops as you reach your deductible.
How can I find out details about co-insurance for my plan?
Co-insurance can vary greatly, from 10% per appointment to over 50% per appointment depending on your plan, plus you have to meet your deductible which can vary from a few hundred to several thousand dollars. Plan benefits can also vary from year to year, so it is important to check with your insurance provider to see if there are any changes (the phone number and/or member portal website listed on the back of your insurance card provide easy access to this information). Royalton Psychological Associates, LLC. will not know your co-pay until we verify your benefits during your first appointment, so we recommend checking with your insurance provider first if you are unsure of your plan benefits.