$1,000-$5,000. For example, if you have a $1,000 deductible, you have to pay the frst $1,000 of your bills and then insurance will kick in and start paying the rest of them.
Copays: This is a fat amount associcopaysated with certain types of care. Your employer chooses these copay amounts and they’re spelled out in your beneft plan, as well as on your insurance card. For example, you might have a $25 copay for every visit with your family physician and a $50 copay with every visit with a specialist physician like a cardiologist or gynecologist.
Coinsurance: This is similar to copay, except it is a percentage, not a fxed amount. Your beneft plan will say where coinsurance is applied and where copays are applied. For example, you may have a 20% coinsurance for outpatient surgery. This means that the insurance company will pay 80% of the bill for the surgery and that you have to pay 20%.
If you have high patient responsibilities like a $3,000 deductible and coinsurances of 40% or higher, do not be upset at the insurance company. Your payments are high, because your employer chose an inexpensive health plan. I’ll tell you what you can do about large patient responsibilities in a later chapter, but if you do fnd these costs to be high, I encourage you to let your employer’s leadership know. They won’t know unless you tell them. This is a major problem in the United States. Businesses are fnding themselves in very competitive situations where they have to compete with companies in Europe and Asia that do not have to pay for employee health insurance.
Understanding in-network and out-of-network
You may have two sets of deductibles, copayments, and coinsurances if your health plan includes something called out-of-network (OON) benefts. To understand out-of-network benefts, you frst have to know what in-network benefts are.
When your employer is trying to buy health insurance, the insurance company will offer them several different options called “health plans.”