Hey guys it’s Alex again. I’m an insurance broker and today I’ll be going over the second most common question we get at our office which is, “How does this insurance work?”
So, first of all, you have something called a deductible. And the deductible is normally what you have to spend for something major like a hospitalization or surgery before your insurance is going to help share in the cost of whatever it is. Once you’ve spent up to your deductible if you still have a bill remaining at that point you typically start to pay something called co-insurance. Co-insurance is a percentage, maybe 20% or 30% that you pay and then your insurance pays the remaining amount until you’ve reached what is called the out of pocket max.
Now you don’t normally reach the out of pocket max unless something really major happens but it’s there to protect you, so you don’t have a huge bill that you are responsible for. So if you have a situation like that you’d reach what is called the out of pocket maximum and once you’ve surpassed the out of pocket maximum; let’s say you still have a bill that goes over that then your insurance typically will pay 100% what goes beyond that point. And for plans going thru the marketplace, they will pay an unlimited amount beyond that.
Before you reach your deductible, you normally have something called a copay and a copay is something that you pay for a visit to the doctor or going to fill a prescription. It’s a flat dollar amount maybe $20 or $50 depending on the plan that you have. All you do is you show your insurance card, go to the doctor, they do whatever they need to do, and you check out at the end at the front desk, and they charge you your copay normally.
I hope that helps you with answering that question.
If you have any other questions you can always reach us at our office at 210-469-3900 or via email at info@futurewiseinsurance.com
Thanks for watching!
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