Well, even though they both happen to start with “Co”, they are not the
same at all. I used to say, “Americans are spoiled on co-pays.” But, more
recently co-pays have become cost prohibitive in many family situations.
Yes, co-pays are really nice to have, which is simply a pre-set cost for your
doctor’s office visit, such as $45 co-pay for your primary doc, and $65 for
any specialist. Of course, some co-pays or more, and a lot of times with
group workplace plans they are generally less. The bottom line is, if the
premiums are comfortably affordable, then you might wish to consider a
plan with co-pays. However, if you are only visiting once annually for your
“wellness checkup” and maybe once because you are a bit sick, then co-
pays could be more costly than the actual “paid visits” might be. Keep in
mind, on non-co-pay plans, you are still receiving the “network discounted
rate” which could be a considerable savings. And all “wellness visits”
should always be $0 in cost! Yes, the choice is always a gamble! So,
here’s the rule of thumb, if you’re very healthy, no need for co-pays, not so
healthy (lots of Dr. visits!), then co-pays may be right for you. If Affordable!
So, if co-pays are simply the amount I pay to visit my doctor, then when the
heck do I need to worry about this “co-insurance?” Hopefully never, and
certainly a rare event for most. First of all, co-insurance is your portion of
what is owed only after you have met your deductible for any given year.
This is typically 20,30,40 or 50%. This percentage (that is your portion) is
important, and generally will come into play, ONLY IF you are having a
minor out-patient type of surgery. Why? Well, in most cases you will “max
out of pocket” if you are admitted in the hospital for any more than 2-3
days. So, in many cases, the percentage of your portion is non-
consequential. But for explanatory purposes, let’s say you have an a out-
patient surgery for $8,000 cost with a $3,500 deductible, and 20% co-
insurance. Here’s the math, $8,000 minus $3,500 (the full deductible you
owe) = $4,500 (leftover). Then you’d still owe 20% of the leftover $4,500
equaling $900, for a grand total out-of-pocket of $4,400. That’s a lot better
than the full $8,000 cost of surgery! BUT generally, (but not always!) if your
total hospital bill is greater than $14,000 (which is quite easy to achieve!)
then you should be prepared for your Max-Out-of-Pocket! In a lot of cases,
$9,450.00!!
If you don’t already have the Allstate Health Solutions Plan Enhancer, then
you may wish to consider calling Kevin and see how you can darn near
eliminate this major out-of-pocket risk. Super easy application with no
health Q’s and hopefully less cost than you might think! Call Kevin
anytime 985-778-0072.
This is a new addition to the “What the Health?” newsletter that I will try to
keep brief and to the point. Hopefully, this may help shed a little light on a
somewhat complex health insurance world.
You’ve got Q’s, I hope I have your answer! Always feel free to call Kevin
most anytime. Text or call 985-778-0072.