By Betty Berry, Tuesday, May 11, 2010 Q: I can’t understand why they make senior healthcare coverage so difficult to understand. Plans refer to deductibles, coinsurance, copayments and share-of-cost. Are these terms interchangeable?
A: The insurance industry, like any other business, has a unique vocabulary to describe its services and fees. Going a step further, each type of coverage could also have unique words to describe the plan. The government plans that cover senior healthcare are no different.
While the terms you mention do sound alike, there are subtle differences and the terms are used in conjunction with different types of healthcare coverage.
A deductible is the initial specific amount of money that the insured is required to pay toward healthcare expenses before the insurance company will start to cover the cost.
You will find this term is used by Medicare Part A (hospital coverage), which has a deductible of $1,100 in 2010 each time you enter the hospital. Part B ( medical coverage) has an annual deductible of $155 in 2010 before Medicare covers costs and, Part D (prescription coverage) could have an annual deductible of up to $310 in 2010 depending on the plan selected.
Coinsurance is the percentage of the cost of care the insured is required to pay after the healthcare plan has paid. Medicare Part B’s coinsurance is usually 20 percent of the Medicare approved amount. Many employers’ plans also use the 80/20 coinsurance ratio, with the insurance paying 80 percent and the patient being responsible for the remaining 20 percent.
A copayment is a fixed amount the insured is required to pay for each medical service received such as a doctor’s visit or prescription purchase. Copayments are usually found in senior advantage plans such as HMOs and PPOs. Copayments usually range from $5 to $25 per service.
The term share-of-cost is associated with the Medi-Cal program. It is actually another way of describing a deductible. The amount of a share-of-cost, however, is not a fixed amount but varies depending on the income of the insured.
Q: A few weeks ago you wrote about a Medicare workshop that was taking place in Thousand Oaks. Any chance that will be repeated in the west county?
A: Yes. The presentation covers “Medicare Basics” and is scheduled for Tuesday from 10 a.m. to noon at the Courtyard Marriott Gazebo Room, 600 Esplanade Drive, Oxnard.
The presenters will walk you through the ABCs of Medicare. Learn what Medicare is and when and how you should sign up for coverage. Find out what Medicare costs and if a medical review is needed to enroll. If you continue to work past 65, learn whether or not you need to enroll or if you can wait until you retire.
The presentation is free, but reservations are suggested. They may be made Monday through Friday from 9 a.m. to 5 p.m. by calling 800-600-4182 or 800-777-1370 for the speech- and hearing-impaired.
This should be a very educational event and one seniors should plan to attend and perhaps bring a friend along.
Friday: 1:30-3 p.m. Panel presentation “Medicare Fraud — How Does It Happen — How Is It Detected — How Is It Investigated” at Goebel Senior Adult Center, 1385 E. Janss Road, Thousand Oaks. For reservations, call 381-2744.
Monday: 1-2:30 p.m. Presentation “Will You Pass Your Next Driving Test?” at Moorpark Active Adult Center, 799 Moorpark Ave. in Moorpark. For reservations, call 517-6261.
— Betty Berry is a senior advocate for Senior Concerns. The advocates are at the Goebel Senior Adult Center, 1385 E. Janss Road, Thousand Oaks, CA 91362; phone 495-6250 or e-mail email@example.com (please include your telephone number). You are invited to submit questions on senior issues.