Co-Insurance versus Co-Pay
Co-insurance and co-pay are cost cutting measures that insurance companies use to make sure they can afford to provide the best possible medical coverage while also meeting the financial needs of the policyholder. Distinguishing between the two is important wheel shopping for insurance and afterward throughout the life of your policy.
Co-payment, often abbreviated to co-pay, is the cash amount that the insured must pay at each visit. On arriving for an appointment at a doctor’s office, the patient pays perhaps twenty dollars before being seen, and that money is a co-pay , the part of the doctor bill that the insured pays before the insurance company is billed.
Co-pays vary in size depending on the plan the insured has selected. They may range from twenty to fifty dollars or more.
Co-insurance is not a dollar amount, but a percentage. One example is a 20% co-payment on in-network care. This means that after the deductible and any uncovered charges are paid, the insured must pay 20% of the remaining bill, and the insurance company pays the other 80%.
Most insurance companies pay a smaller percentage of co-insurance for out-of-network visits than for those physicians that accept their coverage. Some out-of-network policies ask the insured to pay as much as half to the total cost. In any case, the insurance company usually pays a higher percentage as the co-pay and deductible rise.
Co-insurance and co-pay are vastly different things; one a payment before services are rendered and the other a cut of the final bill, but the combination of the two helps insurance companies keep medical expenses in check.
Both co-pay and co-insurance should be considered when shopping for an insurance plan, since they represent cash payments the consumer must come up with at the time of each doctor visit and each medical procedure. While the two are inversely related, both have the same result for insurance companies: they help to keep costs low so customers can afford the coverage they need.
Each insurance company deals differently with pre-existing conditions. Having such a condition just means that the insured already had a health condition before the policy went into effect.
Quite often insurance policies cover pre-existing conditions, although a few general rules may apply. Insurance shoppers should be sure to understand what conditions qualify as pre-existing, what conditions they must meet to accepted and what conditions make it nearly impossible to find affordable coverage.
Every insurance company has its own definition, but usually an illness or injury that was present before the insured applied for coverage is defined as pre-existing. This could mean diabetes or cancer or just pregnancy or obesity. This sort of condition does not automatically exclude consumers from a plan, but stipulations may exist to which the customer must agree before entering the plan.
Among the most common stipulations waiting periods during which the company will not pay any portion of bills for the condition in question, and the requirement that the insured not have gone without insurance for more than 63 days.
The waiting period makes sure the company has time to amass funds in your account to cope with the costs of care. They length of the period is related to the type of condition, and may range from three months to a year.
Insurance shoppers who have anything that might qualify as a pre-existing condition should ask the insurance company specifically if it qualifies and how long their waiting period would be. In such circumstances smaller waits my be a factor in the choice of a plan.
Some types of pre-existing conditions, notably cancer, heart disease and some types of diabetes can make getting insurance at all nearly impossible. COBRA insurance coverage can make the process much easier, but COBRA is not always an option. Customers who must find insurance in spite of a pre-existing condition should speak frankly with a health insurance professional who can direct them to companies that insure people with the condition in question.
Pre-existing conditions are not an absolute bar to finding appropriate health care coverage; rather they make it necessary to carefully question insurance companies in minute detail to see which of them offers a plan that offers the coverage needed at an affordable price. Finding a suitable plan does not become impossible just because of a pre-existing condition, but those with such a condition must exercise patience and stick with the task in order to identify the company with the best policy for any individual’s circumstances.
Finding an experienced local insurance agent is a great asset in the task of finding individual health coverage. The best such representative will have the heart of a teacher and will be willing to go slow and explain exactly what everything means. This is the person who can help their clients find the best policy to cover immediate insurance needs.