North Carolina Health Insurance - Terms of the Policy You Should Understand
One of the most confusing things for people getting North Carolina health insurance is figuring out all the insurance terms. They see the terms “deductible,” “co-pay,” and “coinsurance” all over their paperwork, but really do not understand what they mean. To get the best deal on insurance, though, it is a good idea to understand what each of these terms mean and how they impact the amount of money that comes out of your pocket. Let’s look at each one individually.
What is co-pay? Co-pay is a set amount that the patient pays for each visit to the doctor or each prescription they get. Many policies have set co-pay for visits to a primary physician and a slightly higher one for visits to specialists. For prescriptions, co-pays may be tiered so that generic drugs have a lower co-pay and high-end name brand drugs have a higher co-pay. However to receive these copay benefits on prescription drugs, many North Carolina health insurance carriers require you to meet a separate drug deductible before the copay takes effect. This deductible will usually range from $200-$1000 per person so it’s very important to understand this prior to deciding on the plan for you and your family.
What is a deductible? The policyholder must pay this amount before health insurance begins to cover costs during a policy year. Many policies have deductibles that range from $500 to $10,000. Let’s say you have health insurance with an individual deductible of $1,000. If you have to go for a procedure in the hospital at the beginning of the year that costs $5,000, the health insurance will only work on $4,000 of that total. The first $1,000 comes out of your pocket. The thing that can be confusing is that the deductible often only applies to care associated with hospital or outpatient procedures. Many North Carolina health insurance policies do not require the deductible paid for routine doctor visits or preventative care. Co-pays cover that.
What is coinsurance? Coinsurance can be confusing for many people. It refers to the percentage of the bill that the policyholder owes after the deductible. So, using the above example, there is $4000 left on the bill. If your policy requires you to pay 20% coinsurance and the insurance company covers the rest, you would be responsible for paying the $800 in co-insurance and the insurance company would pay the remaining $3200. In dealing with North Carolina health insurance, it is important to understand what these terms mean so you can prepare your finances in case you need to meet your deductible or coinsurance. It also gives you an idea what your annual co-pays for routine care will be.
