{"id":6810,"date":"2018-06-11T14:55:21","date_gmt":"2018-06-11T14:55:21","guid":{"rendered":"http:\/\/hnetalk.com\/member\/?p=6810"},"modified":"2018-06-13T18:55:53","modified_gmt":"2018-06-13T18:55:53","slug":"cost-sharing-understanding-the-difference","status":"publish","type":"post","link":"https:\/\/hnetalk.com\/member\/cost-sharing-understanding-the-difference\/","title":{"rendered":"DEDUCTIBLES, COPAYS AND COINSURANCE DECODED"},"content":{"rendered":"

Health care terminology can be complicated. We want to help make it easier for you to understand. When you receive medical services, you may have to pay a deductible, a copay or coinsurance. What does that all mean?<\/p>\n

We have broken down each of these terms so you can better understand what they mean when you view your medical claims statement. For a printable pdf version of this example, click here<\/a>.<\/p>\n\n\n\n\n\n\n\n\n\n\n\n
What is a Deductible?
\n<\/strong>A Deductible is the amount you owe for health care services (covered on your plan) before your plan begins to pay. For example, if your deductible is $1,000, your plan will not pay anything until you\u2019ve met the $1,000 deductible for covered health care services.\u00a0Note: Some preventive services are free.*<\/em>
\n<\/strong><\/td>\n<\/tr>\n
\"\"<\/td>\n<\/tr>\n
What is Coinsurance?<\/strong>
\nWith Coinsurance, you share the costs of covered health care services calculated as a percentage (for example 20%) of the allowed amount for the service plus any deductibles you owe. For example, if an office visit is $100 and you\u2019ve met your deductible, your coinsurance payment of 20% would be $20. The plan pays the remaining 80% or $80.<\/td>\n<\/tr>\n
\"\"<\/td>\n<\/tr>\n
What is a Copay?<\/strong>
\nA Copay is a fixed amount (for example, $20) you pay for a covered health care service. The amount can vary by the type of covered health care service.<\/td>\n<\/tr>\n
\"\"<\/td>\n<\/tr>\n
What is Out-of-Pocket Maximum (Safety Net)?<\/strong>
\nAn Out-of-Pocket Maximum or Safety Net is the most you pay for deductibles and certain copays during a policy period (usually a year) before your plan begins to pay 100% of the allowed amount.\u00a0Note: Some copays may still apply.*<\/em><\/td>\n<\/tr>\n
\"\"<\/a><\/td>\n<\/tr>\n
\n

Here\u2019s an Example of How it Works!<\/h2>\n\n\n\n\n
Pat\u2019s Plan Deductible: $1,000<\/th>\nCopay: $20<\/th>\n\u00a0Out-of-Pocket Limit: $2,000<\/th>\n<\/tr>\n<\/tbody>\n<\/table>\n

\"\"<\/td>\n<\/tr>\n

*Please refer to your membership materials for your specific deductible, copay, coinsurance and out-of-pocket maximums.
\n**Plan coverage periods may vary by group.<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n


\n<\/strong>
\n<\/em>
\n
\n<\/strong><\/p>\n

<\/h2>\n

 <\/p>\n

 <\/p>\n

 <\/p>\n","protected":false},"excerpt":{"rendered":"

Health care terminology can be complicated. We want to help make it easier for you to understand. When you receive medical services, you may have to pay a deductible, a copay or coinsurance. What does that all mean? We have broken down each of these terms so you can better understand what they mean when […]<\/p>\n","protected":false},"author":11,"featured_media":6888,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"jetpack_post_was_ever_published":false,"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_publicize_message":"","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":true,"jetpack_social_options":{"image_generator_settings":{"template":"highway","default_image_id":0,"font":"","enabled":false},"version":2}},"categories":[19],"tags":[694,695,697,693,332,699,698,696],"class_list":["post-6810","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-newsletter","tag-coinsurance","tag-copay","tag-cost-sharing","tag-deductible","tag-eobs","tag-explanation-of-ben","tag-health-care","tag-maximum-out-of-pocket"],"jetpack_publicize_connections":[],"jetpack_featured_media_url":"https:\/\/i0.wp.com\/hnetalk.com\/member\/wp-content\/uploads\/2018\/06\/GettyImages-501363398.jpg?fit=724%2C483&ssl=1","jetpack_sharing_enabled":true,"jetpack_shortlink":"https:\/\/wp.me\/p6ZZGa-1LQ","_links":{"self":[{"href":"https:\/\/hnetalk.com\/member\/wp-json\/wp\/v2\/posts\/6810","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/hnetalk.com\/member\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/hnetalk.com\/member\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/hnetalk.com\/member\/wp-json\/wp\/v2\/users\/11"}],"replies":[{"embeddable":true,"href":"https:\/\/hnetalk.com\/member\/wp-json\/wp\/v2\/comments?post=6810"}],"version-history":[{"count":14,"href":"https:\/\/hnetalk.com\/member\/wp-json\/wp\/v2\/posts\/6810\/revisions"}],"predecessor-version":[{"id":6871,"href":"https:\/\/hnetalk.com\/member\/wp-json\/wp\/v2\/posts\/6810\/revisions\/6871"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/hnetalk.com\/member\/wp-json\/wp\/v2\/media\/6888"}],"wp:attachment":[{"href":"https:\/\/hnetalk.com\/member\/wp-json\/wp\/v2\/media?parent=6810"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/hnetalk.com\/member\/wp-json\/wp\/v2\/categories?post=6810"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/hnetalk.com\/member\/wp-json\/wp\/v2\/tags?post=6810"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}