It’s the New Year and with every New Year comes fresh beginnings. Did you know that it can also mean changes with your health insurance?
Many health insurance plans reset annual cost shares (the amounts you pay) on January 1 of each year. This means the amounts you had accumulated towards your out-of-pocket maximum in 2018, consisting of deductible, coinsurance and copays, start over for 2019.
It’s a great time for a refresher on these out of pocket costs and how they work with your plan.
Deductible: The deductible is the amount you pay for covered services before your insurance pays. Let’s say you have a $500 deductible. You receive covered services from an in-network provider and the bill is $500 after insurance discounts are applied. You would be responsible for the full $500 and your deductible would be satisfied for the year.
Coinsurance: Coinsurance is the percentage you pay for covered services once your deductible has been met. For example, you may have a 20 percent coinsurance, this means you pay 20 percent of covered services and your health insurance picks up the remaining 80 percent.
Copay: A copay is a fixed dollar amount that you pay for covered services. You will typically see copays for services such as office visits or urgent care visits. You may also see copays applied for prescription drugs.
Out-of-Pocket Maximum: The out-of-pocket maximum is the most you will pay each year for covered service. This maximum is a combination of your deductible, coinsurance, and copay amounts. After this out-of-pocket maximum is met, covered services are paid by your insurance company at 100 percent. Your out-of-pocket maximum does not include any insurance premium amounts you pay.
It’s important to remember that you save the most money when you use in-network doctors and hospitals. If you use out-of-network doctors or hospitals, you will not only be responsible for higher deductible and coinsurance amounts, but also any amounts over your insurance’s benefit allowance.
If you are a Blue Cross and Blue Shield of Nebraska member, you can check your out-of-pocket costs as well as find in-network doctors and hospitals by creating an account on myNebraskaBlue.com.
It’s worth the time to understand your health insurance benefits better.