UNDERSTANDING YOUR INSURANCE
What is a deductible? A deductible is the amount you pay out-of-pocket for covered services before your health plan kicks in.
An example of how it works: Jenny, 45, is a single professional who just bought her first home, a condo in Boston. She loves that her building has a gym and pool because She likes to stay in shape. She has trouble sleeping and was diagnosed with Obstructive Sleep Apnea. The doctors prescribed a CPAP machine for Jenny.
Jenny will pay out of pocket for the procedure until she meets her $1,000 deductible, the amount she pays for covered services before her health plan contributes. After that, she’ll pay 20 percent of any costs for the rest of the year because her DME and doctor are in network. In the event she has more medical expenses this year, it’s good to know she’ll max out the deductible right away, so she won’t have to pay full price.
What is coinsurance? Coinsurance is the percentage of the bill you pay after you meet your deductible.
An example of how it works: Eric, 28, is a security expert living in Portland, ME with his wife and two small boys. Eric has Sleep Apnea and has been using a CPAP machine for years. He gets replacement supplies, just about every 90 days. The family maxed out their deductible already, so Eric will be responsible for only a portion of the costs ― or the coinsurance ― billed for the CPAP Supplies. With his 20 percent coinsurance, he’ll end up paying a about $60.00. His health plan will pay the remaining portion: In Eric’s case, 80 percent.
What is copay? Copays are flat fees for certain visits.
An example of how it works: Teddy, 34, is a married forklift operator from Concord, NH, He has Type I diabetes. His Primary Care prescribed the use of Continuous Glucose Monitoring (CGM) for him. He gets the CGM supplies every 90 days, his health plan has some fixed costs and only requires $50 copays for each order. Having these set fees gives Teddy peace of mind.