Deductibles, copayments and coinsurance provide ways to share the cost of medical care, making coverage affordable.
Deductibles
Deductibles are provisions that require the member to accumulate a specific amount of medical bills before benefits are provided. For example, if a member's policy contains a $250 deductible, the member must accumulate $250 in covered expenses before reimbursement begins. Most traditional plans feature a $200 to $500 deductible, and then pay 80% to 100% for covered services. With any plan, the higher the deductible, the lower the premium.
Copayments
To Mountain State members, a copayment is usually a fixed fee ($5, $10, $15, $20) the member pays to providers at the time covered services are performed. This means no financial surprises to members.
The level of copayment is determined by the benefit option. Copayments are applied to office visits, emergency room visits, hospital admissions and other medical care under some products.
Coinsurance
After deductibles are met, the plan begins paying a percentage (usually between 80% to 100%) of covered services. The remaining amount, called coinsurance, is borne by the member. Coinsurance is a form of cost sharing.