Washington State Health Insurance : School Me

[Conundrum]

I'm basically an unattractive dude Flo. AK has it right. Mtngirl is off but mostly because insurance contracts are too complicated now.

Copay and coinsurance are not the same thing. The terminology is sometimes used interchangeably and shouldn't be. Copays are flat dollar amounts paid for a service or prescription. They typically don't apply to deductible but do apply to maximum out of pocket. Coinsurance will be listed as a percentage that you pay as a proportion of a charge. Some are after you met your deductible, some are a % of a drug cost. Sometimes you pay a coinsurance amount for services pre-deductible. It all depends on the insurance contracts and over the years, they've become very confusing as insurance companies play games and try to make benefits fit into metallic levels on the governments actuarial value calculator.

The most standard example would be a $1,000 deductible, 80/20% coinsurance, $5,000 out of pocket, $30 copay plan. You would pay $30 to see a general practitioner. For services that don't allow a copay, you'd meet your $1,000 deductible and then pay 20% of charges until you've met your $5,000 out of pocket.

But, there will be things that this example doesn't apply to as insurance contracts become more complicated. Such as an ER copay that is waived if admitted. That copay here is basically a penalty.

[oftpiste]

I just finished up doing some investigating with a very good, helpful broker in SEA. Turns out the best I can do with new insurance is $300+ more a month than my existing, shitty, grandfathered plan for me and two kids.

I'd highly recommend this guy. If you want a referral PM me.

[Cono Este]

In most plans these days coinsurance is only paid between the deductible and max out of pocket. So unless you have a copay for a specific service, like primary visit, you’re 100% on your own until your deductible.

Plans got a lot worse for next yr.


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