Co-insurance: what's yours? (medical, plan, hospital, doctor)

[tvdxer]

What is your co-insurance? Do you find you have difficult paying it?

Many health plans, in addition to having a premium, deductible, and co-pays, also require you to pay for a pro-rated portion of any health expense.

10% and 20% seem like common numbers for in-network providers.

I have no co-insurance, thankfully.

At 20% co-insurance, I would pay something like $900 each time I picked up my monthly prescriptions!

[AnonChick]

I pay $10 when I go to the doctor's office, whether primary care, gynecologist, or in-network specialist.
I pay $50 for outpatient care in the Emergency Room.
I pay $100 for inpatient care, if I'm admitted.
I pay $5 per 90-day prescription of generic meds, $15 per 90-day prescription of brand-name, but only if generic isn't available, OR the mail-order pharmacy doesn't carry the generic and only has the brand name available. Otherwise I have to get the generic, or pay full price for the brand-name.
There's no deductible, and I believe ours is a $100,000/year maximum except in the case of long-term illness, in which case our long-term illness coverage takes over after the first $100,000.

[lifelongMOgal]

$5K deductible, no co-pay, slight prescription discount, I am responsible for all charges my insurance co. deems "allowable".

[Ceece]

There is always a maximum annual out of pocket amount, it's an important piece of info that some folks overlook. If the maximum annual OOP is $4k it is a lot more applealing than if it were $10k. After the OOP is met your bills are covered 100%.

[AnonChick]

Originally Posted by Ceece

There is always a maximum annual out of pocket amount, it's an important piece of info that some folks overlook. If the maximum annual OOP is $4k it is a lot more applealing than if it were $10k. After the OOP is met your bills are covered 100%.

Depends on the plan really. With my plan, if (for example) I go to the PCP because I have a sore throat, and he does a culture, and sends me for bloodwork, and I have to return in 5 days following a prescription for antibiotics to treat strep, and then 2 weeks later for a followup..the total charge for ALL of that is -
$10.

It's all part of the same "incident," so there's only one co-pay. So there's no reason why I'd have a maximum coppay amount, because I can't think of any way I could possibly spend enough on copays to warrant needing a maximum amount. I mean, there's only 365 days to a year, and 104 of those days are weekends when the doctor's office is closed. So only 263 days are available for me to go to the doctor and incur completely new seperate co-pays. At $10/incident, assuming each day was a seperate incident, that'd run me $2630, total, for the year.

And it's likely that there'd be an audit of my medical history before I got even halfway through that doctor office visit marathon, if the doctor didn't just flat out cut me off entirely

[golfgal]

Originally Posted by tvdxer

What is your co-insurance? Do you find you have difficult paying it?

Many health plans, in addition to having a premium, deductible, and co-pays, also require you to pay for a pro-rated portion of any health expense.

10% and 20% seem like common numbers for in-network providers.

I have no co-insurance, thankfully.

At 20% co-insurance, I would pay something like $900 each time I picked up my monthly prescriptions!

What is retail on those---YIKES.

We have a co-pay of $25 for office visits for general care, preventative care is covered at 100% so nothing there, $12 for most prescriptions, $6000 family deductible then 100% coverage after that.

[tvdxer]

Originally Posted by golfgal

What is retail on those---YIKES.

We have a co-pay of $25 for office visits for general care, preventative care is covered at 100% so nothing there, $12 for most prescriptions, $6000 family deductible then 100% coverage after that.

The main drug (Temodar) retails for about $4,000 (for a five-day cycle, which has to be repeated each 28 days) in the dose size I take.

[golfgal]

Originally Posted by tvdxer

The main drug (Temodar) retails for about $4,000 (for a five-day cycle, which has to be repeated each 28 days) in the dose size I take.

Don't move out of MN because most states don't have a plan like MN Care

[Ceece]

Originally Posted by AnonChick

Depends on the plan really. With my plan, if (for example) I go to the PCP because I have a sore throat, and he does a culture, and sends me for bloodwork, and I have to return in 5 days following a prescription for antibiotics to treat strep, and then 2 weeks later for a followup..the total charge for ALL of that is -
$10.

It's all part of the same "incident," so there's only one co-pay. So there's no reason why I'd have a maximum coppay amount, because I can't think of any way I could possibly spend enough on copays to warrant needing a maximum amount. I mean, there's only 365 days to a year, and 104 of those days are weekends when the doctor's office is closed. So only 263 days are available for me to go to the doctor and incur completely new seperate co-pays. At $10/incident, assuming each day was a seperate incident, that'd run me $2630, total, for the year.

And it's likely that there'd be an audit of my medical history before I got even halfway through that doctor office visit marathon, if the doctor didn't just flat out cut me off entirely

Well...DO YOU have a maximum out of pocket amount? It may or may not include your deductible but it does include your copay and COINSURANCE (which is different). COINSURANCE can be something like 20% after deductible per-whatever. If you are hospitailized or need ongoing, expensive treatments it can add up. It usually isn't an issue if you just have a sore throat once a year and are talking about an office visit or two, but when your health goes it sometimes goes hard.

[Curmudgeon]

For me (Medicare) I have no copay for doctor/hospital services. Those are all taken care of by my supplement for which I pay no premium and I'm reimbursed for the Part B premium in my retirement check. I also have full prescription coverage (not Medicare Part D) as part of my retirement benefits. For a 90-day supply of generic drugs I pay $10. For name brands I pay $40.

My wife's insurance is also premium-free but with a $500 deductible, $20 copay for doctor visits, $50 for emergency room outpatient and 20% for in-patient hospitalization. Her prescription coverage is the same as mine. Thankfully, she'll be "transitioning" into Medicare next year so her benefits will mirror mine. It's the one time she's looking forward to getting older!