<aside> 👉 **Navigating insurance coverage can feel like trying to decipher a complex puzzle sometimes.

With all the jargon, fine print, and varying policies, it's no wonder it can be confusing!

But hey, you're not alone in this labyrinth of insurance intricacies. Take a deep breath, and remember, it's okay to feel a bit overwhelmed.

Understanding your coverage might take some time, but with a bit of patience and maybe a helping hand from our team, you'll crack the code in no time.

Read on, and soon enough, you'll be confidently making sense of your insurance coverage like a pro!

REMEMBER: In Reach will provide you with a breakdown of your insurance coverage before the start of services. We LOVE helping our patients and families understand their coverage and the advocate for accurate claims processing for you every single day!

Reach out to us at [email protected] with any questions!**

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What is a copay?

A copay (or copayment) is a flat fee that you pay on the spot each time you go to your doctor or fill a prescription. For example, if you hurt your back and go see your doctor, or you need a refill of your child's asthma medicine, the amount you pay for that visit or medicine is your copay.

Not all plans use copays to share in the cost of covered expenses. Or, some plans may use both copays and a deductible/coinsurance, depending on the type of covered service. Also, some services may be covered at no out-of-pocket cost to you, such as annual checkups and certain other eligible preventive care services.

What is a deductible, and how does it work?

A deductible is the amount you pay each year for the most eligible medical services or medications before your health plan begins to share in the cost of covered services. For example, if you have a $2,000 yearly deductible, you'll need to pay the first $2,000 of your total eligible medical costs before your plan helps to pay.

What is coinsurance?

Coinsurance is a portion of the medical cost you pay after your deductible has been met. Coinsurance is a way of saying that you and your insurance carrier each pay a share of eligible costs that add up to 100 percent. The higher your coinsurance percentage, the higher your share of the cost is.

You pay for coinsurance after you meet your deductible.

What is an out-of-pocket maximum?

Out-of-pocket maximum is the most you could pay for covered medical expenses in a year. This amount includes money you spend on deductibles, copays, and coinsurance. Once you reach your annual out-of-pocket maximum, your health plan will pay your covered medical and prescription costs for the rest of the year.

Here’s an example! You have a plan with a $3,000 annual deductible and 20% coinsurance with a $6,350 out-of-pocket maximum. You haven’t had any medical expenses all year, but then you need surgery and a few days in the hospital. That hospital bill might be $150,000.

You will pay the first $3,000 of your hospital bill as your deductible. Then, your coinsurance kicks in. The health plan pays 80% of your covered medical expenses. You'll be responsible for payment of 20% of those expenses until the remaining $3,350 of your annual $6,350 out-of-pocket maximum is met. Then, the plan covers 100% of your remaining eligible medical expenses for that calendar year.

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