Knowing the differences between Medicare Co-Insurance and Supplemental Insurance allows the healthcare consumer to make informed decisions that fit their needs.
In today’s healthcare environment, terminology is very confusing, yet important for the consumer to understand. Medicare has many features unique to this governmental program, but also has aspects that are similar to other health insurance policies. Understanding these definitions can help the consumer make informed decisions that will be right for their individual needs.
Medicare Co-Insurance is the portion of the cost of services the consumer is required consumer to pay. Medicare Supplemental Insurance is an insurance sold by a private insurance company to help the consumer pay for some of the Medicare Co-Insurance costs, as well as deductibles and other costs Medicare does not cover.
Every participant in the Medicare program is required to pay a co-insurance. Each individual makes the determination of whether a supplemental insurance policy is right for their healthcare needs. Without supplemental insurance, the consumer pays the provider directly for the co-insurance costs. When a supplemental insurance is purchased, the consumer pays premiums to a third-party insurance company. This third party then makes payments to the provider to pay for the costs incurred by the patient.
Co-Insurance is paid after the Medicare deductible has been met and Quite often, this amount is 20% of the Medicare-approved cost. For example, Simon has met his deductible for the year and has a medical provider who accepts Medicare assignment. On his last visit, his doctor ordered a CT scan which is normally charged at $250. The Medicare allowance for this is $100, so Medicare will pay $80 to the provider, and Simon’s Medicare Co-Insurance cost will be $20. In other words, the 20% is not based on the original charge by the provider, but rather by the accepted Medicare allowance for the specific procedure.