How do deductibles and co-insurance work and which are best for you and your family?
All PPO (Preferred Provider Organization) plans have deductibles and co-insurance. Many HMO (health maintenance organization) do not have them. Now you also have pre-ventive services such as annual women’s exams, men’s PSA exams, well-baby care, etc. due to the changes coming from health care reform and health insurance rates. Most plans will have some doctor visits available at a specified co-pay. These might be unlimited in number on compre-hensive plans or they may be limited to 3-6 co-pay visits, after which additional visits would go against your deductible. Provided doctor co-pays, Rx coverage, sometimes alternative care (like chiro), preventive services and sometimes accident coverage (waived deductible or first dollar coverage to a certain amount) will all be available before the deductible is met. Usually excess co-pay visits, lab services, diagnostic tests and imaging, ambulatory surgeryies, hospitalizations, maternity, etc. would be subject to deductible and co-insurance.If you are quite healthy and have no need but for 2-3 dcotor visits per year including your annuals, you may never meet your deductible and the co-insurance is really irrelevant. Deductible choices usually range from $500 or $1,000 on the low end up to $7,500 or $10,000 on the high end. In our current economy the $2,500 and $5,000 deductible have become very popular as people try to cut back on costs. Let’s say you have a $50,000 issue be it disease or accident. And let’s say you have $2,500 deductible and 80/20 co-insurance.
You will be responsible for the first $2,500 of expense and then during the co-insurance you will pay 20% of each dollar for say $15,000, so your stop/loss where you stop paying is $17,500. You would owe the $2,500 deductible plus 20% of the next $15,000, or a total of $5,500. Your carrier would pay $44,500 promptly and the doctors and hospitals would work with you on the $5,500 over the next 3-4 years. Be sure to check out Kanetix health insurance in Ontario to see which insurance providers offer the best rates.
