A health insurance deductible is a dollar amount that you must pay towards your medical bills before the insurance company begins paying a significant portion of the bills. Some health insurance companies make you pay the full deductible amount before offering any assistance and some offer benefits before the deductible. In either case, the deductible is typically followed by a Maximum Out Of Pocket (MOOP) amount. It is important to know that the MOOP amount INCLUDES the deductible. After the deductible and before the MOOP you pay Co-Insurance.
When you see a plan referred to as 80/20, or maybe 70/30, this is the co-insurance amount. This distinguishes what percentage of your medical bills the health insurance company will pay AFTER you have paid the deductible. In an 80/20 plan, after you pay your deductible, the insurance company pays 80% of your medical bills for the rest of the year. As you pay the other 20% you start chipping away at the remaining MOOP amount. Once you meet the Maximum Out Of Pocket the health insurance company will pay 100% of your medical bills for the remainder of the year. Other common co-insurance amounts are 50/50, 90/10 and 100/0.
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