MetLife Copays, Deductibles, and Coinsurance Definitions
It can be challenging to predict the costs associated with health and dental care. When patients are navigating insurance coverage, it is important to be familiar with some key terms. This includes premiums, copays, deductibles, and coinsurance. A copay and a deductible are expenses that patients will pay out of out-of-pocket. Insurance plans can have different deductibles and copays. The main difference between these things is how much patients are expected to pay and when the payment will be due. Below is a summary of key terms used in insurance.
Premium
Premiums are regular payments, typically paid on a monthly basis, required to maintain an insurance plan. These premium payments are sent to insurance providers like MetLife. Higher premiums are generally associated with lower deductibles and copays.
Copay
The copay or copayment is a set amount that the individual pays for a service from a provider or for a prescription. A copay is due to the provider when the patient receives service. The patient may also have a copay for prescription medications. The plan’s copay is typically printed on the insurance ID card, which identifies the individual’s responsibility. Copay rates are specific to the insurance plan and do not typically go towards the patient’s deductible.
A patient may not have a copay as this is plan-specific. In some cases, the plan may use a deductible that is combined with a copay or coinsurance. Other plans work by covering the cost of specific services. Dental insurance often covers preventative care, which includes things such as an exam and routine cleaning.
Deductible
A plan’s deductible is a set amount that the individual is responsible for paying on an annual basis. This includes covered services and medications. Once a deductible is met, the insurance plan will begin to help cover the cost of covered services.
Deductibles are different from the monthly premium associated with the plan. Once a patient meets their deductible, they will receive assistance from the plan for covered services. In order to maintain the plan, individuals still need to pay their monthly premiums.
Coinsurance
The coinsurance is a portion of the cost, once the deductible is met. When coinsurance kicks in, costs are shared between the patients and the insurance provider. Plans with a higher coinsurance percentage mean the individual is responsible for a larger portion of the cost. The patient will be responsible for covering any charges which fall are not covered by the plan.
Plan Selection
Patients who are generally healthy and do not expect big medical or dental costs can often benefit from a plan with a higher deductible and lower premium. If a patient has a serious medical condition or expects to need costly medical or dental care, they will often be better off with a plan that includes a lower deductible and higher premium. This type of plan helps cover more costs and is helpful for patients with complex health problems or greater medical needs. MetLife has various dental plans available to customers.
Call the office today to schedule an appointment. Our team looks forward to working with you to maintain good oral health. We are also happy to answer your dental insurance questions.
To learn more about our billing and insurance coverage, contact us.