Co-Pays, Co-Insurance, & Deductibles: Explained
As healthcare costs continue to rise, it is helpful to understand the various terms related to your medical insurance plan. If you are seeing an ophthalmologist or optometrist for a medical reason (cataracts, dry eyes, diabetes, glaucoma, etc), you might encounter three essential terms: co-pay, co-insurance, and deductible.
Let's explore what they mean and how they impact your financial responsibility.
Co-Pay:
A co-pay is a fixed amount you pay for a specific medical service, diagnostic test, routine eye exam, or contact lens fitting. Your insurance plan determines the amount of your co-pay.
Co-Insurance:
Co-insurance is a percentage of the cost of medical services you're responsible for paying after meeting your deductible. For example, if your insurance plan has a 20% co-insurance rate, you would pay 20% of the cost of the service, and your insurance company would cover the remaining 80%.
Deductible:
A deductible is the amount you must pay out of pocket for medical services before your insurance plan starts covering your costs. For example, if you have a $1,000 deductible, you're responsible for paying the first $1,000 of medical expenses before your insurance kicks in. Once you've met your deductible, you may still be responsible for co-pays and co-insurance, depending on your plan.
*Co-insurance and deductibles may come into play if you need more specialized services, such as cataract surgery or treatment for macular degeneration, diabetic macular edema, or glaucoma.
Understanding your co-pay amount, co-insurance rate, and deductible helps not to be surprised by unexpected bills. If you have any questions or concerns about your insurance coverage, don't hesitate to contact your insurance provider for clarification.*