We’re still some weeks away from open enrollment season, but are you ready for the health insurance maze that’s about to come baring down at 90 miles an hour? Here’s a preview of the fun that’s about to hit you in the face:
How could a mere copay, which you may think of as that annoying $20 or $30 flat charge you pay when you see a doctor, have such financial impact? Isn’t coinsurance usually a small percentage? Both can carry more weight than you’d think. A copay can be hundreds of dollars if it is your share of an emergency-room bill. And coinsurance, your percentage of the cost of a service, may be a modest 10 percent or it could be the entire 100 percent. It also matters whether the copay or coinsurance is charged before you’ve met your deductible or afterwards. If before, you no longer have to make these payments when you’ve paid off your deductible. If after, the obligation is open-ended and may cost you more.
Here’s a reality-grounded example: a plan in the U.S. News universe with a premium of $500 a month and a relatively low annual deductible of just $750. But U.S. News Best Health Insurance Plans shows that the plan’s out-of-pocket limit of $2,500 doesn’t include the deductible. That effectively pushes the out-of-pocket limit to $3,250.
That’s not all. The out-of-pocket limit also doesn’t include coinsurance on prescriptions, physician visits, hospital stays, or any other medical expense. Coinsurance is pegged at 30 percent or more in this plan for virtually every costly service, so in addition to your premium and deductible, you’ll be responsible for nearly one-third of every medical cost you accrue, from brand-name drugs to ER care. If you get a hospital bill of $10,000, you’ll pay $3,000 of it in addition to your deductible.
Are you ready for open enrollment season? Tell us about it in our discussion forum!
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