Let’s use some examples to show how all of this works together. To start, we’ll say you’ve got an insurance policy with a deductible of $2,000 and an out-of-pocket maximum of $5,000. This plan has a coinsurance of 20%.
Now imagine you come down with a respiratory illness, so you schedule a visit with your doctor. Between all of the tests and medications the bill works out to $300.
Since you haven’t hit your deductible, you would owe the entirety of the $300. But that payment brings your remaining deductible down from $2,000 to $1,700 and your OOP max. down to $4,700.
Later that year, you take an unfortunate spill while hiking and break your arm. Between the hospital bill and the x-rays the total works out to $3,500.
First, you would pay the remaining $1,700 on your deductible. With the deductible covered, you now only owe a 20% coinsurance for the rest of the bill. Of the remaining $1,800, you pay $360 (your 20% coinsurance), while your provider pays the leftover $1,440.
Your remaining deductible is now $0, and your OOP max. is at $2,640.
Note: For some policies or services a coinsurance may be assessed before deductible is met. In those cases, the coinsurance payment does not contribute to paying down the deductible.
Now this turns out to be an unlucky year, and you discover that you’ll need knee surgery. After all is said and done the cost will be a whopping $20,000.
Your deductible is met, so you would only owe your 20% coinsurance. That would usually work out to $4,000 (20% of $20,000) BUT… you’ve only got $2,640 remaining on your out-of-pocket maximum!
You pay $2,640 and your insurance provider covers the rest of the $17,360.
Any further covered services during this plan year would be paid 100% by your insurance provider!
Now you should have a basic idea of how your insurance coverage will affect your medical costs, as well as how your medical costs will affect your insurance obligations. Of course, the specifics of your coverage will depend on the details of your insurance policy. With this understanding, you should be able to make a more informed choice when selecting what health services and products are right for you!
If you’re ever unsure if one of our products is covered by your insurance, Aeroflow will gladly help you find out where you stand on your deductible and which brands best fit your coverage!
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Information provided on the Aeroflow Healthcare blog is not intended as a substitute to medical advice or care. Aeroflow Healthcare recommends consulting a doctor if you are experiencing medical issues or concerns.