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Health Insurance Terms Made Easy

– Deductible. This is the amount you owe for services your plan covers before the insurance company will pay a claim. For example, if your deductible is $1,000, you will have to pay that amount before your coverage kicks in. However, it doesn’t apply to all services, which means that some things, like preventative care or doctor’s visits, may be covered before you’ve reached that $1,000 mark.

– Copayment (COP) vs. coinsurance (COI). COP and COI are two ways that health insurance companies can share the cost of the services with the patient. While they both have the same purpose, they’re a little bit different. COP is a fixed amount that you pay whenever you get a specific service. For example, a visit to your primary care doctor will cost you $20 every time you go. You may also pay $10 for each generic prescription that you have filled. COI, on the other hand, is a percentage of the cost of the service rather than a fixed number. For example, with COI, you will be charged 20% of the cost of the visit if you see your primary care doctor, and the cost of the visit will vary depending on the nature of the treatment during that visit. Likewise, for a generic drug, you would pay a fixed percentage that would vary by the drug’s cost and its tier. Most companies negotiate discounted rates with physicians and pharmacies, which means that you’re usually responsible for a percentage of that discounted rate.

– Prescription drugs. The difference between COP and COI can be confusing when it comes to pharmaceuticals because of the different drug tiers. Each health insurance plan will come with a drug formulary to help you understand what you’ll be paying for in that area specifically.