ACA for Dummies

Discussion in 'Health Care Reform Forum' started by supersupps, May 9, 2013.

  1. supersupps
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    supersupps Well-Known Member

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    Calling Ann.
    Can someone explain, in plain english the difference betw the exch plans that have co-insurance vs co-pays. Difference in oop for co-ins vs co-pay.. prem diff? what will people choose and why? which is better and why?

    Co-ins Co-pay
    hosp 10% $250 up to 5 days
    home health 10% $20
    SNF 10% $ 150 up to 5 days
    - - - - - - - - - - - - - - - - - -
    I tired to make the chart better spaced. but site wont allow.. sorry
     
    Last edited: May 9, 2013
  2. timsip
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    timsip Well-Known Member

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    Do you understand that we are full time insurance agents that take our time to exchange information with each other? We don't have time to train you how to be an insurance agent. This forum is full of all the information you need. You read it, don't ask us to be your personal trainers.
     
  3. Yagents
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    Yagents Well-Known Member

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  4. leevena
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    leevena Well-Known Member

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    Copays mean the amount the patient pays when they incur an expense. A $100 office visit, employee pays a $25 copay and the carrier pays the remaining $75.

    Coinsurance means that there is some kind of co-sharing of the expense. For example, a $1,000 charge (employee has a $100 deductible, and a 80/20 coinsurance of the next $2500) the employee pays $100 deductible and then 20% of the next $900.

    A $250 per hospital confinement copay means that when hospitalized the patient is required to pay $250 per day, so if they are there for 3 days it is $750. Sometimes there is a maximum amount of days to which the copay applies, such as 5.

    The other SNF Home health follow the same.

    Did this answer your question?
     
  5. supersupps
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    supersupps Well-Known Member

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    I work in MA. of course I know this , MY question is why someone would choose co-pay vs co-insurance. and why?
     
  6. anonymous1
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    anonymous1 Well-Known Member

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    Depends on the product what the copay is vs what the co insurance is in another product. Sometimes seeing a solid number for a co pay looks better than a 20% co insurance for a same procedure. On ma some co pays do not count towards their moop Just depends
     
  7. Yagents
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    Yagents Well-Known Member

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    Most copay plans come with coinsurance also.
    Most who choose copays, think they can buy a doctor for $35
    Most who choose coinsurance, aren't focused on Max OOP
     
  8. supersupps
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    supersupps Well-Known Member

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    My question is which is best for client.. which one is typically more expensive for monthly premium? co- insurance or co-pay?
     
  9. Yagents
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    Yagents Well-Known Member

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    Refer it to another agent that knows the answer
     
  10. leevena
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    leevena Well-Known Member

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    Neither, both, I don't know!

    Sorry for the sarcasm. How would anyone on this site know what is best for a client that we don't know?

    The premium cost for any kind of an plan is based on many things, not just the play design, although plan design will play a large part.
     

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