You may have to pay the $100 difference.Your plan covers a maximum of $200 for an X-ray.Let's say your doctor charges more for an X-ray. These limits help keep rates fair and reasonable, which helps lower costs for all members. Your plan covers up to a certain amount for tests, procedures and medical services. Your out-of-pocket cost, or coinsurance, is $40.What you pay to see your doctor depends on your coinsurance, which in our example, is 20%. You've met your annual $5,000 deductible so your plan now pays for benefits. Copayments are different than coinsurance. That means you have to pay 20 each time you go. You bruise your hip in a fall and you need an X-ray. Lets say your plan has a 20 copayment for routine doctors visits. Example #2: Coinsurance After You've Met Your Deductible A plan is good for one year.Īt the start of each year, your deductible and coinsurance resets for the next plan year and the $5,000 deductible and 20% coinsurance will start again. When the amount of coinsurance you've paid reaches $6,000, the plan covers 100% until your "plan year" renews.After that, your plan covers 80% of the costs, and you pay the other 20%.You must pay the first $5,000 of your medical costs.Example #1: Deductibles, Coinsurance and Out-of-Pocket Maximums Here are a few examples of how deductibles, coinsurance and maximum limits work together. ![]() Once you understand the different parts of your health insurance costs you’ll want to know how these work together and what your out-of-pocket costs may be.
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