Why Do I Pay More for Healthcare with Insurance? Understanding Deductibles, Coinsurance, and Chargemaster Rates

Have you ever received a medical bill that seemed much higher than you expected, even though you have health insurance? You’re not alone. Many people are surprised to learn that they can sometimes pay more for healthcare services with insurance than they would without it. In this blog post, we’ll explain why this happens and what you can do to make sure you’re getting the most out of your health insurance plan.

Deductibles and Coinsurance

One of the main reasons why you might pay more for healthcare with insurance is because of your deductible and coinsurance. A deductible is the amount of money you have to pay out-of-pocket before your insurance starts to cover the cost of your medical expenses. Coinsurance is a percentage of the cost of your medical expenses that you have to pay after you’ve met your deductible.

For example, let’s say you have a health insurance plan with a $1,000 deductible and a 20% coinsurance. If you go to the doctor for a $500 checkup, you’ll have to pay the first $1,000 out-of-pocket. After you’ve met your deductible, your insurance will cover the remaining $400, but you’ll still have to pay 20% of that amount, or $80.

So, in this example, you would pay a total of $1,080 for your checkup, even though you have health insurance. If you didn’t have health insurance, you would have only paid $500. This is because the deductible and coinsurance increased the total cost of your care.

Chargemaster Rates

Another reason why you might pay more for healthcare with insurance is because of chargemaster rates. Chargemaster rates are the prices that hospitals and other healthcare providers charge for their services. These rates are often much higher than the rates that insurance companies negotiate with providers.

For example, let’s say you go to the hospital for a chest X-ray. The chargemaster rate for a chest X-ray is $1,200. However, your insurance company may have negotiated a rate of $500 with the hospital. So, if you have insurance, you would only pay $500 for the X-ray. However, if you didn’t have insurance, you would have to pay the full chargemaster rate of $1,200.

What You Can Do

If you’re concerned about the cost of your healthcare, there are a few things you can do:

Shop around for health insurance plans. There are many different health insurance plans available, so it’s important to compare plans and find one that meets your needs and budget.
Understand your deductible and coinsurance. Make sure you know how much your deductible and coinsurance are, so you can budget for healthcare expenses.
Ask your doctor or healthcare provider about the cost of services. Before you receive any medical services, ask your doctor or healthcare provider how much they will cost. This will help you avoid any surprises when you get the bill.
Negotiate with your healthcare provider. If you’re having trouble paying for your healthcare, you may be able to negotiate with your healthcare provider. They may be willing to reduce their fees or offer you a payment plan.
Seek out financial assistance. There are many programs available to help people pay for healthcare costs. If you need financial assistance, contact your local health department or social services agency.

By following these tips, you can make sure you’re getting the most out of your health insurance plan. And if you have any questions about your health insurance coverage, don’t hesitate to reach out to us for help.