About.com Health Insurance

Copays and Coinsurance. What's the Difference?

Sun, 07 Feb 2010 12:13:17 +0000

Ah, health insurance jargon!

What's the difference between a copay and coinsurance?� I have been asked this question many times through email, but�after being asked the same question by a friend at a party last night, I decided a blog on the subject was a good idea.

Although you may be paying a hefty monthly premium for your health insurance (or a percent of what your employer pays), your health plan most likely does not cover 100% of the cost of your healthcare. Additional costs (or out-of-pocket expenses) that you may be responsible for include�an annual deductible, copayments, and co-insurance.

Copayments
A copayment (or copay) is a fixed-dollar amount that you pay each time for certain services. �Most commonly, you will be responsible for a copayment each time you have a doctor's visit and for each prescription medication you fill. For example, with my health insurance, I pay a $15 copayment for each primary care physician visit, $25 copayment for a specialist visit, and $20 for each brand-name prescription.

Coinsurance
Coinsurance is a percent of the cost of your care. You are responsible for paying the co-insurance amount. For example, if a doctor's visit is $100 and you have a 20% coinsurance, you will pay the doctor $20 and your health plan will pay the doctor $80.

Copayments are most often used in HMOs and for services you receive from a network provider in a PPO. Coinsurance is often used when you get services from an out-of-network provider in a PPO. This can be quite costly, especially if you use an out-of-network hospital for a surgical procedure.

Please leave a comment below or in the Health Insurance Forum.

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Copays and Coinsurance. What's the Difference? originally appeared on About.com Health Insurance on Sunday, February 7th, 2010 at 12:13:17.

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Have a Question or Complaint About Your Health Plan? Contact Your State�s Health Insurance Department.

Wed, 03 Feb 2010 17:38:02 +0000

I have been getting a lot questions about health insurance coverage and how specific health plans work. Although there are federal laws (such as COBRA and HIPAA) that help to protect people with health insurance, most health insurance is regulated at the state level.

Insurance Department Websites

Many states have consumer websites that provide information about local health plans, including how to make a complaint, how well health plans perform, and general advice about health insurance. Some good examples are the health plan consumer guides from Vermont and New York.

You can link to your state's health insurance department on the website of the National Association of Insurance Commissioners. Not all of the state websites are user-friendly and you may have to "dig around" to find the information.

Some states make it quite easy to get information and answers to health insurance questions. For example, Missouri has a tool (Ask Insurance) that allows you to ask questions online. I tried this on behalf of one of a friend in St. Louis, and received an answer in less than 24 hours.

Additional State-Specific Resources �

Several organizations provide useful information for each state concerning your health insurance rights and what state programs are available for people who cannot afford to buy insurance. These resources include:

The Foundation for Health Coverage Education provides a website Coverage for All that has user-friendly tools and guides--booklets, pamphlets, a toll-free Help Line, web tools and presentations to help you understand your health plan options. ��
The Georgetown University Health Policy Institute has written a Consumer Guide for Getting and Keeping Health Insurance for each state and the District of Columbia. These state guides summarize your health insurance rights and protections in each state.

Please leave a comment below or in the Health Insurance Forum.

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Have a Question or Complaint About Your Health Plan? Contact Your State�s Health Insurance Department. originally appeared on About.com Health Insurance on Wednesday, February 3rd, 2010 at 17:38:02.

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February is American Heart Month - Keep Your Heart Healthy and Your Insurance Premiums Low!

Mon, 01 Feb 2010 19:19:05 +0000

If you�develop heart disease or one of the risk factors for heart disease, such as high blood pressure, high cholesterol,�or diabetes, your healthcare costs may be very high. Not only will you have to take more medications and have more doctor visits,�but you may have difficulty getting health insurance (because of a pre-existing condition) or you may have to pay higher insurance premiums and out-of-pocket expenses.

A�healthy diet and lifestyle can help you fight heart disease and prevent some of the risk factors for heart attack. The following articles from About.com provide useful information about determining your risk of heart disease and what you can do to prevent it:

Please leave a comment below or in the Health Insurance Forum.

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February is American Heart Month - Keep Your Heart Healthy and Your Insurance Premiums Low! originally appeared on About.com Health Insurance on Monday, February 1st, 2010 at 19:19:05.

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Medicare "Donut Hole� Causes Some Seniors to Skip Diabetes Drugs

Thu, 28 Jan 2010 15:06:02 +0000

According to a recent study, Medicare beneficiaries with type 2 diabetes who reach the coverage gap in their Part D prescription drug benefits--known as the "donut hole" -- have higher out-of-pocket medication costs and are less likely to stay on their medications than those who have supplemental drug benefits.

The study - Falling into the Coverage Gap: Part D Drug Costs and Adherence for Medicare - by Vicki Fung, Ph.D. and colleagues from Kaiser Permanente and the David Geffen School of Medicine at UCLA, appears online in the journal Health Services Research.

According to several online press releases, Dr. Fung noted: "We found that having a gap was associated with lower total drug spending among diabetes patients compared with having no gap. However, at least some of these cost savings were due to beneficiaries reducing their use of chronic medications, which may result in worse health outcomes."

Medicare Part D Coverage Gap

If you have a Medicare Part D prescription drug plan, the coverage gap is when Medicare temporarily stops paying for your prescriptions. If you are in the coverage gap, you have to pay the entire cost of your medications.

I have type 2 diabetes along with several related health conditions. Each year, I hit the coverage gap, or donut hole, in August and pay full price for my medications until the end of the year. The sudden jump from paying less than $100 each month to over $400 a month is upsetting and I can understand why people cut back on their medications.

Learn More About Medicare Part D Donut Hole:

Please leave a comment below or in the Health Insurance Forum.

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Medicare "Donut Hole� Causes Some Seniors to Skip Diabetes Drugs originally appeared on About.com Health Insurance on Thursday, January 28th, 2010 at 15:06:02.

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Are My Health Insurance Premiums Tax-Deductible?

Mon, 25 Jan 2010 13:05:30 +0000

It's tax time again and you may be wondering if your health insurance premiums are tax-deductible. It depends on who you are and who you work for.

Self-Employed: If you are self-employed, the answer often is yes -- the premiums you pay to cover yourself and your dependents probably are tax-deductible. They are not, however, if you, your spouse, or your dependents are covered by another employer's group health insurance plan.

Health Savings Accounts: If you work for a company that offers health insurance as part of what's known as a cafeteria plan, you may have a health savings account (HSA). The contribution you make to your�HSA is 100% tax deductible up to a limit of $5950 for�family coverage and $3,000 for�individual coverage -- for 2009.

If you are�not self-employed, and you don't work for a company that provides health insurance with a cafeteria plan,�the Internal Revenue Service (IRS)�allows you to count health and dental insurance premiums as part of the 7.5% of your adjusted gross income that has to be spent on health care before any out-of-pocket medical expenses can be deducted.

Health and dental insurance premiums can be counted toward that 7.5%. A long list of health-related expenses also can be deducted, including prescription medications and optional surgical procedures, like laser eye surgery to correct vision. The IRS has a list on its website.

Take a look at what the IRS allows you to deduct for health-related items and make sure to keep complete records. And, if you have any questions, speak with a tax advisor.

Please leave a comment below or in the Health Insurance Forum.

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Are My Health Insurance Premiums Tax-Deductible? originally appeared on About.com Health Insurance on Monday, January 25th, 2010 at 13:05:30.

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Get "Extra Help" Paying for Your Medicare Prescription Drug Costs

Fri, 22 Jan 2010 15:06:00 +0000

If you have Medicare and limited income and resources, a change in the law makes it easier for you to save on the cost of prescription drugs. By changing what counts as income and assets, an additional one million Medicare beneficiaries (seniors and some people with disabilities) may be eligible for "Extra Help" paying for their medications.

The changes to the Extra Help program went into effect on January 1, 2010.

If you are enrolled in a Medicare Prescription Plan (Part D), you may be able to get extra help to cover the costs of your monthly premium, annual deductible, and medication copayments. The "Extra Help' program may also provide coverage in the donut hole.

To qualify for extra help, you must be on Medicare (have Medicare Part A Hospital Insurance and/or Medicare Part B Medical Insurance), have limited income and resources, and live in one of the 50 states or the District of Columbia.

According to the Social Security Administration (SSA), to qualify for extra help:

Your resources must be limited to $12,510 for an individual or $25,010 for a married couple living together. Resources include such things as bank accounts, stocks, and bonds.�The SSA�does not count your house and car as resources; and
Your annual income must be limited to $16,245 for an individual or $21,855 for a married couple living together.
Even if your annual income is higher, you still may be able to get some help. Some examples where your income may be higher are if you or your spouse:
- Support other family members who live with you;
- Have earnings from work; or
- Live in Alaska or Hawaii.

For more information about "Extra Help" including online applications, go to:

Extra Help with Medicare Prescription Drug Plan Costs (Social Security Online)
Access to Benefits Coalition

Even if you were not eligible before, check again.��If you qualify, you may save more than $3500 in 2010!

Please leave a comment below or in the Health Insurance Forum.

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Get "Extra Help" Paying for Your Medicare Prescription Drug Costs originally appeared on About.com Health Insurance on Friday, January 22nd, 2010 at 15:06:00.

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Got a Question About Your Health Insurance? Ask Dr. Mike!

Mon, 18 Jan 2010 17:02:04 +0000

One of my greatest joys is to share my health-related knowledge and experience in a way that engages people and helps simplify their journey through the healthcare system. As a physician and health educator, I'm committed to helping you receive the information that you need to make informed decisions about your health.

I will be happy to answer questions about your health insurance. If I don't have the answer, I will research it for you or provide you with resources that are credible and up to date. If the answer to your question is of interest to other readers, I may post it as a FAQ or in my Blog or newsletter.

Please understand that I cannot make any decisions for you regarding your health insurance requirements. Hopefully, I can point you in the right direction so you can make an informed decision that best meets your healthcare coverage and financial needs.

If you cannot afford health insurance, I may be able to help you find resources in your state and give you some tips on how to save on your healthcare.

To ask me a question about health insurance, email me at healthinsurance.guide@about.com.

What do you think? Leave a comment below or in the Health Insurance Forum.

Please be aware that I cannot provide any medical advice, recommend any treatment for you, or diagnose a health problem. Please consult your healthcare provider if you have specific concerns about your health.

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Got a Question About Your Health Insurance? Ask Dr. Mike! originally appeared on About.com Health Insurance on Monday, January 18th, 2010 at 17:02:04.

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Haiti's Devastating Earthquake

Fri, 15 Jan 2010 11:20:41 +0000

I have been deeply distressed watching all the news reports from Haiti. As a pediatrician, I am especially saddened by the plight of Haiti's children, who make up half of that country's population.�

If you would like to respond to the Haitian crisis, you can find information about safe places to donate on the website of Joanne Fritz, the About.com guide to nonprofit charitable organizations.

My thoughts and prayers are with the people of Haiti and the thousands of relief workers who are responding to the crisis.

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Haiti's Devastating Earthquake originally appeared on About.com Health Insurance on Friday, January 15th, 2010 at 11:20:41.

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Generic Drugs and Health Reform

Thu, 14 Jan 2010 11:44:32 +0000

According to Jon Leibowitz, Chairman of the Federal Trade Commission (FTC), the federal government and consumers could save $35 billion over 10 years if Congress bans deals in which makers of brand name drugs pay potential generic competitors to keep their less expensive medications off the market.

Pay-for Delay Ban in House Version

The current health reform bill passed by the house includes an amendment that would ban these so-called "pay-for-delay" agreements. Several lawmakers from the House held a news conference yesterday and referred to a report from the FTC that found pay-for-delay arrangements are on the increase and, on average, can delay the availability of generic drugs for 17 months.

The Senate health reform bill does not include a ban on pay-to-delay. Since it is expected that the final overall health reform bill will most likely resemble the Senate version, there is a possibility that the pay-to-delay provision will be lost.

Drug Companies Disagree with Ban

Companies that make brand name and generic drugs oppose the ban on pay-to-delay claiming that the legislation goes too far and could hurt consumers by making some generic drugs more costly or slower to come to market.

Learn More About Generic Drugs:

�Please leave a comment below or in the Health Insurance Forum.

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Generic Drugs and Health Reform originally appeared on About.com Health Insurance on Thursday, January 14th, 2010 at 11:44:32.

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Share Your Medication Saving Tips with Dr. Mike

Tue, 12 Jan 2010 11:42:15 +0000

Since I started as the About.com health insurance guide, I have written about how you can save money on your prescription drugs. In fact, I even created a section of the site called "Saving Money on Your Prescription Drugs" that has nine articles about ways to save.

With the economy in trouble, I have no doubt that many of you are struggling with the high cost of healthcare, especially prescription medications. I've shared many of my thoughts and ideas about how to save. Now I would like to hear from you.

Have you hit the Medicare donut hole in 2009? Did you lose your job and, along with it, your health insurance and drug coverage? How do you save when you need to buy medications for yourself and your family?

Please leave a comment below or in the Health Insurance Forum.

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Share Your Medication Saving Tips with Dr. Mike originally appeared on About.com Health Insurance on Tuesday, January 12th, 2010 at 11:42:15.

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