Insurance 101 2017-06-26T09:37:31+00:00

In general, insurance has 4 major parts: deductible, co-insurance, out of pocket maximum, and copay. The deductible is always the first cost to you. The deductible on your plan is the first portion of cost sharing between you and the insurance company. You pay 100% of the contracted physician rate until you reach your deductible. Once you reach your deductible, you move into “Phase 2” of insurance, the co-insurance. This is a percentage, such as 25%. Co-insurance is a sharing of costs between you and your insurance company. If your co-insurance is 25%, then you’ll pay 25% of the physician’s contracted rate, and your insurance company will take care of the remaining 75%. Most of the time, a co-insurance doesn’t last forever, it only lasts until you’ve reached your out of pocket maximum for the year. Once all of your covered medical expenses reaches a certain point, then the insurance company takes over to pay 100% of your covered medical care for the rest of the calendar year. The out of pocket max never includes your premium payments to the insurance company or charges that are either not covered or done with a non-contracted physician/facility. A copay is the 4th part of insurance. It is a flat dollar amount that you pay, generally for doctor’s visits or prescription medications, instead of having to pay the whole cost of the visit. A copay can be described as a “deductible bypass”. Your copay does not count towards your deductible, but does count towards your out of pocket maximum. Not all plans have copays as part of the insurance plan.

Short Term Insurance – A short-term plan provides insurance for up to 3 months and may be the right plan for you if you are:

  • Between jobs
  • Waiting for coverage to start at a new job
  • A recent graduate
  • Needing insurance coverage outside of the Open Enrollment period for purchasing a plan

Contact Us so we can help you assess your needs and get you matched to the right plan!