David asked in Business & FinanceInsurance · 10 years ago

what does 50% coinsurance after deductible mean?

I am trying to apply for health and insurance and it says 50% coinsurance after deductible.

the annual deductible is $3500

what does this mean?

8 Answers

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  • 10 years ago
    Favorite Answer

    It means, AFTER you pay the first $3500 in medical bills every year, you also pay half of the REST of the medical bills. $100,000 of medical bills will leave you paying almost $52,000. Ouch.

    It's a crappy plan. It's probably really cheap.

  • Anonymous
    4 years ago

    Coinsurance After Deductible

  • 5 years ago

    I just came across this. I see it s 5 years old, so there have definitely been some changes with the health insurance industry and regulation.

    On healthcare.gov health insurance marketplace, I noticed that the Bronze plans for Blue Cross Blue Shield in Illinois now have this "30% coinsurance after deductible" or 20% after deductible for primary and specialist doctor visits. I almost couldn t believe it after I saw it.

    This is the first I ve seen the "after deductible" thing anywhere. I wonder if people know what a big difference that is from the other plans. The deductible was way higher than what the original post mentioned, $6,250 individual and $13,700 family. The one with the 20% coinsurance after deductible has a deductible of $6,800 individual and $13,700 family. Then there is one that is no charge after deductible and deductible is $6,000/$13,100. And I wouldn t call the plans cheap at $430 - $456 per month, though it s a bit cheaper than their silver plans which did not have this "after deductible" nonsense and cost $ - $ .

    This seems ridiculous to me. You will be paying for the whole doctor visit everytime you go to the doctor, until you pay $6,250 - $6,800? Wow. And $1,000 emergency room copay, ouch.

  • 10 years ago

    It means that after you’ve paid out your full deductible amount for the year, you’ll still have to pay 50% of the bills for the covered medical services in question. Kinda scary. But here are a couple things to keep in mind:

    First, not all medical services always apply towards the deductible. The insurance company may cover preventive screenings and tests without you having to pay anything towards the deductible (and without having to pay coinsurance) for those services.

    Second, it may be that not all medical services fall under that coinsurance rule. Without more information from you, it’s hard to tell. Some health insurance plans only apply coinsurance to specific types of medical care.

    So, if you’re considering this health insurance plan, take a look at those two things. Still, it may not be the best plan for you. If you haven’t already done so, I’d recommend that you work with a licensed agent (online or in your area) – preferably one that represents multiple insurers. It doesn’t cost anything extra to work with an agent and it can go a long way towards helping you find the best match for your personal needs and budget.

    Best of luck.

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  • 4 years ago

    What Does Coinsurance Mean

  • 10 years ago

    A) That means that you pay half the bills after you've paid the first $3500 of your bills.

    B) You're obviously not using an insurance broker. Fix that problem first. You shouldn't be "trying" to apply for insurance. You should be consulting with an insurance broker to help you find the right plan. Trying to do it on your own is something fools do. It costs nothing to use a broker and they know about all of the plans you can buy (at least good ones do). If you call Blue Cross, for example, directly -- they will know absolutely nothing about what Kaiser offers. The broker will know what both offers, they've probably been selling insurance longer than the customer service rep at either company, the probably know more about how the policies actually work, AND the price through the broker is EXACTLY the same as buying direct. And, later on, if you end up not liking the broker you can still call the company directly for service.

  • 10 years ago

    Wow..I bet that policy is inexpensive. It means that the first $3,500 of medical expenses each year come out of your pocket. After that, the insurance company will pay 50% of your medical bills - if you have a $100 office visit, they pay $50. You also might want to check if they pay 50% of the full amount or if they use a usual and customary schedule meaning that if the UAC for an office visit is $70 and the doctor charges $100, they pay $35 (50% of the UAC of $70) and you would pay $65 ($100 for the office visit minus the $35 the insurance pays).

  • 10 years ago

    You pay the first $3500 of medical bills and half of the rest.

    For example, if there are $10,000 of medical bills, then you pay $3500 plus 1/2 of the other $6500 for a total of $8250, and the insurance company also pays 1/2 of $6500, which is $3250.

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