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Understanding California Health Plan Co-Insurance
Posted by nick_niesen on October 29th Authentic Falcons Jersey , 2010


First, what is the official definition of co-insurance?


Coinsurance


Once you have met your deductible, you pay coinsurance for additional medical care. It is a percentage of the billed charge. For example, your insurance company might pay 80%, and then you would pay 20%. It is similar to a co-pay Qadree Ollison Falcons Jersey , but is a percentage instead of a dollar amount.


Now, let's dig a little deeper. With California health insurance, it is common to speak of their plan as an 8020 plan or a 7030 plan. They are essentially referring to the co-insurance part of it. With the 8020 example, the health carrier is picking up 80% of the charges and you are picking up the remaining 20%. If there is any kind of deductible, you must pay that first at 100% until met.


Let's take an example and see how California health insurance plans essentially break down into three main stages.


Stage 1 - The deductible YOU PAY 100%


Let's say you have a $500 deductible. Except for services that are separate from the deductible (usually office visits and prescriptions...see COPAYS) John Cominsky Falcons Jersey , you will pay the discounted charges at 100% until you meet your deductible. You can find more information on deductibles.


Stage 2 - The co-insurance YOU SHARE A PERCENTAGE


Once the deductible is met, you then start sharing the cost with the carrier. Let's say our plan is 7030 and the charge is $1000. You pay the first $500 (deductible) and then you pay 30% of the remaining $500...or $150. Of the first $1000 charge, you would pay $650 out of it. If you have another $1000 charge in that same calendar year, you would pay 30% of the 1000 (or $300) since your deductible was already met. When do you stop paying the 30%??


Stage 3 - The Max Out of Pocket THE CARRIER PAYS 100%

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