Understanding Copays & Deductibles

UNDERSTANDING COPAYS & DEDUCTIBLES

Understanding health care can be confusing. That’s why it’s helpful to know the meaning of commonly used terms such as copays, deductibles, and coinsurance. Knowing these important terms may help you understand when and how much you need to pay for your health care. Let’s take a look at these terms to better understand what they mean, how they work together, and how they are different.

What’s a deductible?

A deductible refers to the amount of money you pay for healthcare services before your health insurance plan kicks in. For example, if you’re on a medical plan with a $1,500 annual deductible, it means that you are personally responsible for paying the first $1,500 you accrue in healthcare expenses that year. After that initial $1,500 has been paid, your health insurer will begin to pay for all or some of your care.

What’s a copay?

Once you’ve reached your deductible, you might still need to pay some money to access certain healthcare services. This fixed out-of-pocket amount is known as a copay, and it means that you are sharing the cost of care with your insurance provider. For example, you might pay a $25 cost per appointment every time you visit your doctor, or $10 to refill a prescription.

What is coinsurance?

Coinsurance is a portion of the medical cost you pay after your deductible has been met, and your health plan kicks in. Coinsurance is a way of saying that you and your insurance carrier each pay a share of eligible costs to add up to 100%.

Here’s an example of how coinsurance works once you’ve met your deductible. If your coinsurance is 20%, you pay 20% of the cost of your medical bills. Your health insurance plan will pay the other 80%. Let’s say you meet your annual deductible in July. In August, you need an surgery that costs $2,000. Your coinsurance share is 20%. That means you need to pay $400 ($2,000 x 20%). Your insurance company pays the other $1,600. The higher your coinsurance percentage, the higher your share of the eligible cost is.

Out-of-pocket maximums

Both deductibles and copays count toward your annual out-of-pocket maximum, which means that once you’ve reached a certain figure in both deductibles and copays, your insurance will cover 100% of medical costs without you needing to share those expenses. In other words, a health insurance plan with a low out-of-pocket maximum will mean less money spent in deductibles and copays – but you could end up paying more in monthly premiums.

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At Shipp & Wooten Eye Center we have found that many of our patients have found relief from chronic migraines with Botox® injections. If you have fifteen or more headache days each month with migraine pain that lasts four hours or more, and regularly miss work or activities you enjoy because of debilitating migraine symptoms, there’s an effective alternative to taking headache and migraine prescription medications each time you feel a migraine coming on. Discover why Botox® may be the best proactive solution to managing your migraine pain. Botox® is the most prescribed branded chronic migraine treatment. Surprising, isn’t it? Most people think of Botox® as a cosmetic injectable that smoothes out fine lines and wrinkles across your forehead and around your eyes. While Botox® is certainly an effective anti-aging treatment, it’s also an FDA-approved chronic migraine therapy. When your provider at Shipp & Wooten Eye Center injects Botox® into seven specific muscle areas in your head and neck, the botulinum toxin — a neurotoxin that occurs in nature — helps reduce migraine pain for the next 12 weeks. How Botox® works to help you manage migraine pain? Botox® for migraines is a preventive medication. You don’t wait until you have symptoms to take it, but rather it helps prevent migraines from starting in the first place. Initially, you begin with two Botox® treatments spaced about 12 weeks apart. After your initial two Botox treatments, if you’re having fewer headaches each month, then you can continue receiving Botox injections every 12 weeks, or as your health care provider at Shipp & Wooten Eye Center recommends. During each appointment, your provider injects Botox® into the muscle groups of your head and neck. The needle is so tiny that you feel something similar to a pinprick, but nothing really painful. The injections aren’t deep either, so discomfort is minimal and temporary. Botox® goes just below your skin into the targeted muscle groups. The medication enters the nerve endings that contribute to your migraine pain. There, the botulinum toxins block the release of chemicals that transmit pain signals to your brain. As a result, the pain networks that usually come to life with the onset of a migraine no longer activate, so you don’t feel the usual pain and migraine symptoms. Botox® for migraines could cut your headache days in half. After a series of Botox® injections for migraine pain, you may have up to eight to nine fewer headache days each month. For many women and men, that’s like cutting your migraine symptoms in half — especially if you suffer from 15 or more headache days each month. Imagine waking up ready to take on the day more often than not, thanks to Botox® injections for migraine pain. When it comes to dealing with migraines, would you rather rely on prescription medications you take as soon as you feel symptoms coming on, or are you ready to try a more preventive approach with simple Botox® injections you only need every three months? We invite you to learn more about Botox® for migraines by scheduling a consultation today. Call our friendly office staff at the Shipp & Wooten Eye Center or request an appointment online.