[nan918]

Can someone please explain to me what co-insurance is? Explain it to me in the SIMPLEST terms, as if I am stupid!! :D

I'm looking to change from my current cobra group plan with BCBS - PPO (which is extremely expensive) to an individual BCBS PPO plan.

Thanks!!

[Fr_Chuck]

Co insurance is the amount of money you pay out of your pocket to the doctor, hospital and so on.

For example most BCBS group plans at work have low deductables and low co pays, but normally individual plans have much higher

For example you may have a 2000 deductable which means you will have to pay 2000 before the plan pays anything, and then you co-insurance will be 20 or 30 percent. For example if your bill was 10,000 and you were on a 80/20 plan, you would pay 2000 of that bill on the co pay.

I am not downing BSBC but you may really want to price around, esp coming off cobra ( which is very high) BCBS is a group of separate companies not one large company and many have had some finicial issues. Plus on individual plans coming off cobra you can normally find a better price.

[nan918]

So, after I pay my deductible of $2,000 out of my pocket towards the $10,000 bill, when does the co-insurance kick in? Do I then have to pay more towards the remaining $8,000 bill?

Thanks for responding...

[ScottGem]

COBRA allows you to extend coverage when you terminate employment. It allows you purchase the same coverage you had while employed, but at the group rates paid by your previous employer. Only you have to pay the whole rate, not just the employee portion.

Co-Insurance could mean a few things. It would help to see the context.

[Fr_Chuck]

Ok, it all depends on what policy you get, some policies have a 2000, 5000 or even a 10000 deductaable you have to pay before the policy will pay anything, it just depends on which one you buy.

The co payment can be anything from 50 percent to 0 percent depends on the amount your policy pays.

And it is only of the standard and customany amount,

If for example you have a 2000 deductable, and a 80/20 plan,

If you had a 10,000 bill, you pay the first 2000 before they pay anything, plus 20 percent of the 8000 or another 1600, so you would be paying 3600 of that 10000 bill. ( and that is only if the entire 10,000 was billed on reasonalble and customary charges and if the doctors and the hospital was part of the plan.

What I ran into last month, my hosptial ER is in the plan, but the ER doctors were not part of the plan, so they billed about double of the reasonable and customary charge, so I have to pay that half since it is not even covered by insurance.

Also there are often other fees, some policies require you to pay the first 100, or 400 of any hospital stay,


Then you get into doctors visits and drugs, not all plans include these, and they may have separate co pays and separate deductables,

The best way and to me the only way is to sit down with an insurance agnet and let them explain these to you.