United Healthcare Copays, Deductibles, and Coinsurance Definitions
The cost of dental care and health care can be incredibly challenging to predict. The following terms are important to understand when navigating insurance coverage premiums, copays, deductibles, and coinsurance. A summary of these key insurance terms is outlined below.
Insurance Premiums
An insurance premium is a regular payment that is typically paid on a monthly basis. The premium must be paid in order for the patient to be covered under the insurance policy. The premium payment is sent to United Healthcare or another insurance provider. In most cases, a higher premium is associated with a lower copay or deductible.
Deductible
The deductible is a set amount the individual is responsible for paying annually for covered services and medications. Once a deductible is satisfied, the insurance plan starts helping pay for covered services.
It is helpful to think of the deductible adding up throughout the year. At the beginning of the plan year, patients will be responsible for paying the full amount of covered health care costs. This occurs until they meet the set annual deductible. Every time the patient pays for something that goes towards their deductible, it contributes to the total amount required to pay for the year. Once the total deductible amount is reached, the insurance plan will begin to pay a portion of the costs for the rest of the plan’s year.
The deductible will reset at the beginning of the plan’s year. It is also possible for the deductible to change at the start of a new year’s plan.
Copays
The copay associated with a plan is the amount individuals are required to pay for services. This set amount is due at the time of service. A copay applies to services and prescription medications. The plan’s copay is printed on the insurance ID. These rates are specific to the insurance plan. In most cases, they do not count towards the patient’s deductible.
A copay is specific to the insurance plan, and some plans use a deductible combined with a copay or coinsurance. A plan may also work by covering specific services or preventative care. Dental insurance coverage often includes preventative services like examinations, x-rays, and routine cleanings.
Coinsurance
Coinsurance is a percentage of the cost of a covered service. Patients will pay for 100% of out-of-pocket costs until they reach their deductible. Once the deductible is met, the patient and the insurance provider will both pay a portion of the associated costs. Coinsurance typically ranges from about 20% to 40% for the patient, and the provider will be responsible for paying the remainder of the cost. The specific coinsurance percentages will vary based on the specific plan.
Selecting a Plan
When a patient is healthy and does not expect big dental or medical costs, they may benefit from a high deductible plan, which includes a lower monthly premium. Those with medical conditions or patients who anticipate needing medical or dental care will typically be better suited for a plan with a higher premium and lower deductible. These plans aid in covering more costs and are beneficial for patients with greater medical needs and complex health problems. UnitedHealthcare has a variety of health and dental plans available to customers.
Patients should contact the office today to discuss our services and schedule an appointment. We look forward to answering any questions you have.