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Members Ask –
"What is the difference between a co-pay and coinsurance?"
 Both co-pay and coinsurance make you responsible for part of your healthcare bills. Both are forms of cost sharing, meaning that you pay part of the cost of your care and the Trust pays part of the cost of your care for certain benefits. These allow the Trust to offer a lower rate to members.
Your Summary of Benefits and Cost identifies the co-pay and coinsurance you are responsible for various types of service.
The difference between co-pay and coinsurance is in:
- how the share of cost is divided between you and your health insurance company.
- the total amount you may be responsible for.
How a Co-pay Works
A co-payment is a set amount you pay whenever you use a particular type of healthcare service. For example, you might have a $20 co-pay to see a primary care doctor and a $10 co-pay to fill a prescription. You pay the co-pay amount and the Trust pays the rest of the bill. Your co-pay for that particular service doesn't change, no matter how much the doctor charges, or how much the prescription costs.
Unlike a deductible that's only paid once per year, you pay the co-pay each time you use that type of healthcare service. So, if you have a co-pay of $20 for doctor's office visits and you see the doctor three times for your sprained ankle, you'll have to pay $20 each visit, a total of $60.
How Coinsurance Works
Coinsurance is the percentage of the cost of a healthcare service you are responsible for. The Trust pays the rest of the cost. For example, if you have a 20% coinsurance for hospitalization, this means that you pay 20% of the cost of the hospitalization, and the Trust pays the other 80%.
Since the Trust uses a network to negotiate for discounted rates from their in-network providers, you pay the coinsurance on the discounted rate. For example, if you need an MRI, the MRI facility might have a standard rate of $600. But, since the Trust's network has negotiated a discounted rate of $300, your coinsurance cost would be 20% of the $300 discount rate, or $60.
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Is there a limit to what I must pay?
Yes! It is called the "Out-Of-Pocket Maximum"
The out-of-pocket maximum is the point at which you can stop taking money out of your own pocket to pay for deductibles, co-payments, and coinsurance. Once you've paid enough toward deductibles, co-pays and coinsurance to equal your health plan's out-of-pocket maximum, the Trust will begin to pay 100% of your covered health care expenses for the rest of the year. Like the deductible, the money you've paid toward the out-of-pocket maximum resets at the beginning of each year. See your benefit summary for your out-of-pocket maximum.
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What’s the right way to help someone who is sick?
 We are often at a loss how to best be there for a friend or family member who is suffering an illness. Here are some quick ideas to help:
1. Use the right words. When trying to cheer the person up with words, avoid using phrases like “I can’t believe this happened”, “Look on the bright side” or “It could have been much worse”. These phrases, though full of good intention, can make the person feel guilty for being sick. It’s better to simply acknowledge how you care about them and feel bad for what they are going through. And then listen more than talk.
2. Don’t ask; do. Rather than ask, “What can I do?” or “Tell me what I can do to help”, take charge and just do something. Cook a meal or two and bring it over. Offer to run an errand or take them to the doctor or sit with them for treatment. Offer things in a clear and direct way. This will make it easier for them to accept your help.
3. Give them some extra attention. Call often, even if you just leave a message. Be sure they know you will stick with him or her no matter what. Because, it turns out, some friends disappear when someone gets sick. This may happen simply because they don’t know how to handle the situation or what to do. Don’t be one of those who vanish. Be there for them.
3. Don’t show up empty-handed. Bring something, anything! Flowers, of course, or something from your garden, or something you made. Books and magazines are always appreciated.
4. Be there, just be there. Spending time together can be one of the most comforting things. Just being in the room counts. Watching a favorite movie, reading, or playing games is always appreciated.
5. Give the caregiver a break. A spouse or other caregiver is often on duty 24 hours a day. Why not offer to spend part of a day with your friend to give that angel some respite? Let the caregiver have a massage, go to the gym, run errands or just get some much-needed rest.
6. Send something. When you can’t be there in person, why not send a weekly card? Or a package with some light reading you think your friend might like. Just let them know they are on your mind.
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