Understanding deductibles can be tricky, if you are like most Americans, you face sticker shock every time you need to use your health insurance and are asked to pay huge out-of-pocket amounts of money. This is because health insurance companies’ primary goal is to make a profit; there is no obligation to provide you with insurance at the most reasonable cost possible. Therefore, understanding how your insurance works is important in making the best financial decision for you and your family.
The first term to understand is the deductible, which is the amount of money you will pay out of pocket before your insurance company pays anything. To keep your monthly premium, which is the monthly amount you pay just to have insurance, affordable, you or your business will choose a high deductible, typically ranging from $2500-$5000. So if you need an MRI for the back pain that has been plaguing you, you will be paying the first $2500 yourself.
The next term to understand is your coinsurance, which is the percentage of your health care costs that you will still pay yourself after you have met or paid your full deductible. A common coinsurance is 80/20, which means that you pay 20% of the amount out of pocket while the insurance company pays 80%. So now let’s say that the MRI costs $3,000. The patient pays the first $2500 as the deductible and then an additional 20% of the remaining $500, or in this case, $100.
The final term to understand is your copay. This is a fixed amount that you pay at the time of service, ranging from $40-$100 for most insurance plans. So now for that $3000 MRI, the patient pays $2500 (deductible) + $100 (coinsurance) + $100 (copay), meaning you will pay $2700 for the MRI and your insurance company will pay $300. Keep in mind that this does NOT include the cost for the interpretation by the radiologist, which will be another $300-$500.
- Your copay does NOT count towards your deductible
- Your Insurance premium does NOT count towards the deductible
- Your deductible resets every year, and you start over
Health Guardian Imaging offers fair pricing!