First: What Is Coinsurance?
In a nutshell, the term “coinsurance” applies to the amount of money you pay toward a given health insurance claim. It’s “your share”. With most insurance policies, once the year’s deductible is met, you’ll end up paying “coinsurance”. So just as a sort of baseline descriptor, if you had a coinsurance payment of 15%, your insurance provider would pay 85% of a bill.
What coinsurance pertains to may differ per policy. But just to break it down, a $10,000 bill with a 15% coinsurance stipulation would come to $1,500 from you, and $8,500 from your policy provider. The lower the coinsurance responsibility, the higher the coverage from whoever your insurance provider is.
Now it’s notable that different sorts of policies will have different unique qualities defining them. For example, if you’re insured under an HMO, then regardless of coinsurance, getting medical service from a provider not specified by your HMO policy could mean you are entirely responsible for the associated bill.
Factoring In Coinsurance
So what makes sense when you think of coinsurance is just changing the term to “personal responsibility”. Also, look at the link to get an idea of how such solutions work, and what specific aspects of your particular health situation may mean for overall coverage. Just as no two people are exactly the same in terms of health, different policies have different overall effects.
There’s this massive misconception that paying for health insurance every month means when you have to go to the doctor, then your insurance completely covers the expense. That’s just not the case. While there are more representative programs out there, some almost totally covering your costs, most just aren’t going to do that.
This means it’s integral, for your best health, that you keep a fund set aside to cover coinsurance costs when you’re in a position where you need to sustain some sort of medical solution. Also, look for more representative options. Beyond private health insurance and government solutions for children, the elderly, and the poor, there are employer options.
Employer health insurance can sometimes be the most comprehensive of all, but there are other situations where it barely covers anything and you don’t find out until you decide to take advantage of whatever dental package comes with your job. It’s rather irritating to find out you owe 80% of the bill to the dentist only after you’ve had the work done.
Can You Get By Without Health Insurance?
Thankfully, as of 2019, the “individual mandate” of the Affordable Care Act (alias “Obamacare”) was dropped. What some do is pay no insurance fees for health, waiting instead until some issue crops up and they need medical attention. When you consider that average health insurance costs are $200 for a single male ($2,400 a year), that can be wise.
Essentially, instead of paying $200 to a company, you can now just put $200 away a month. In ten years, that’s $24,000. You can keep that money in an investment fund which can compound its value over time. If you start doing that in your mid-twenties, by your mid-thirties, you’ll have a sizable sum. Until later age, you’re not likely to need expensive procedures.
Weighing All Your Options
That said, you might need unexpected medical help. So even if you’re in the peak of health, for some people, it’s wiser to pay for health insurance every month. Even so, keep in mind what, traditionally, health insurance won’t cover. There are always exceptions but expect no coverage for elective or cosmetic procedures, beauty treatments, off-label drugs, or new tech.
That said, regardless of coinsurance, should you experience health insurance coverage denial, you can appeal for exceptions or allowances using your specific situation or prognosis as evidence.
Coinsurance is your responsibility, the rest of the coverage should be your health insurance provider. And thankfully, you’re not compelled by law to maintain any health insurance whatever. If you can save a little every month, that’s a real option. So before you sign on the dotted line with any insurance company, weigh all the alternatives carefully.
