Insurance Basics You Must Know

So your finally covered with your new health insurance plan through Covered California, or you have renewed for the 2nd year. There are some basics terms you need to understand when it comes to your health insurance. Today we are going to go over a couple of the “Basics” terms in insurance.

The first term is: Annual Deductible

Your Annual Deductible –  The Amount you Pay before your Coinsurance Kicks In.

Your annual deductible is the amount you must pay for covered care each year before your health insurance begins to pay. For example, a $2000 deductible will require you to pay $2,000 out-of-pocket for covered services before insurance company pays.


Next Term: Coinsurance

Your Coinsurance – The Amount You Pay after DeductibleYour coinsurance is the percentage of medical cost you are required to pay after  your annual deductible is met. For example, the health insurance plan may cover 80% of charges for a covered surgery, leaving you responsible for the other 20%. The 20 percent you must pay is called the coinsurance


Next: Annual Out-of-Pocket Maximum

Your Annual Out-of-Pocket Maximum – The Maximum Amount You Will Pay Each YearYour annual out-of-pocket maximum is the absolute maximum amount of money you will pay for covered services during a year. Once you reach your annual out-of-pocket maximum, your health insurance plan covers your medical costs at 100 percent.


Lastly is Copayment

Your Copayment- The Cost of a Doctor Visit
or Pharmacy Item
Your co-payments (or copays) are set dollar amounts you pay to your medical providers for specific covered services. The most common types of copay’s are doctors visit copays and pharmacy copays. For example, you may make a $30 copay for each covered visit to your primary care provider. Often, copay are capped at a certain number of uses per year.

If you still have questions about your health care coverage please feel free to contact our offices at (909) 797-3302.