To find the most affordable individual health insurance coverage, it’s important to learn some health insurance concepts. For example, what do copays and coinsurance mean? They’re both related to what you pay when you use health care services and can have a big impact on your out-of-pocket costs throughout the year.
Important Terms to Know
Copayments (or Copays) – An amount you pay for a covered health care service, when you receive the service. For example, if you have an office visit with your primary care physician (PCP), your copay may be something like $20. If you have tests done, you may have to pay additional costs, depending on your individual health insurance coverage.
Coinsurance – Your share of the costs of a covered health care service, after the deductible is met.
Deductible – The amount you owe for health care services before your health plan starts paying.
Maximum Out-of-Pocket (MOOP) – The most you will pay in calendar year for covered services. This does not include your monthly premium.
WHICH IS MORE AFFORDABLE?
Some plans only have copays. Others have just deductibles and coinsurance. If that's not confusing enough, some plans have both. One best option for every person or every situation is unlikely. The option that's most affordable for you will depend on what you're looking for in your individual health insurance coverage.
All plans have a MOOP (maximum out-of-pocket). This is the most you will pay in one year. You can think of this MOOP as a bucket that can be filled up. You don’t have to fill it up, but if you do, then you are covered at 100 percent for the rest of the year.
Things that may fill up the bucket –
Copay-only plans feature some of the highest premiums, but offer predictable costs when using health care services. For some people, this type of health insurance may actually be the most affordable. For example, those who require a lot of health care may find these plans to be a perfect fit.
COPAY / DEDUCTIBLE / COINSURANCE PLANS
With this type of plan, you have copays for some services and coinsurance for others. You won’t fill up your bucket as quick with copays, however knowing that you have a low, set cost for a doctor visit can be ideal for some members. These plans also tend to have more affordable premiums and the coinsurance is designed to cover the bulk of costs if hospital or specialty care is needed.
DEDUCTIBLE / COINSURANCE ONLY PLANS
With this type of plan you don’t have copays, so if you go to the doctor, you will pay the full cost of that visit until you meet your deductible. The tradeoff is you will likely have lower monthly premiums and filling up your bucket will likely be quicker.
The most affordable individual health insurance for you depends on how you expect to use your insurance. Now that you know the differences between plans with copays, coinsurance and those with both, compare Wisconsin health insurance quotes with a variety of copay and coinsurance options here.
Still have questions? Talk to one of our helpful and knowledgeable customer service representatives at 800.362.3310.