Many people are confused about the differences between an insurance deductible, co-pay and coinsurance.

In short, all three represent the portion of the medical bill that you are responsible for in case you get sick or injured. Another term used is out-of-pocket expense. However, there are some very unique differences between each one.

Deductible

An insurance deductible is usually a fixed dollar amount that you have to pay out of your own pocket before the insurance will cover the remaining eligible expenses.Depending on the insurance plan, the deductible can range from $0 all the way up to thousands of dollars. As a rule of thumb, the higher the deductible the lower the premium (also known as the price to buy the plan), and the lower the deductible the higher the premium.

Coinsurance

Coinsurance is usually a percentage, and represents the percentage cost that you will need to pay and the insurance plan will pay towards your eligible medical expenses. Some common coinsurance examples include: 100%, 80/20, 90/10 and 50/50 – so if you have 80/20 coinsurance on your insurance plan, it means that the insurance company will cover 80% of your medical cost and you are responsible for paying the other 20% yourself. A deductible is commonly use together with coinsurance. In this case you would pay the deductible amount first and after you would have the left over coinsurance amount.

Copayment

Copays are similar to deductibles, in that it is usually a fixed amount of money you have to pay each time you need to use your insurance plan. Unlike deductibles, copays tend to be smaller dollar amounts and are applied on a per visit basis so that that you would have to pay it each visit. As an example, for an office visit to a physician for a cold or flu, you may have a $20 office visit copayment that would be due from you and paid to the office.

In the past, typically insurance plans had some combination of deductible, coinsurance and copayments. In more and more plans, it is becoming more common to have just a deductible.

The Patient Relations and Communications Department at Diagnostic Imaging Service stands ready to assist you with insurance related questions, to assist in verifying your insurance benefits and to identify in good faith an estimate of any financial expense you would incur as a result of an imaging test. Insurance is a complicated world. DIS is here to do everything we can to help navigate that world.

Call 504-459-3220 to speak to one of our experienced patient relations and communications associates regarding financial and insurance matters. Or, click here to send us a secure email asking for assistance with insurance-related matters.

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