coinsurance. cost sharing policies service benefit policies use three cost- sharing features,...

Coinsurance

Upload: oswald-may

Post on 03-Jan-2016

212 views

Category:

Documents

0 download

Report

Download

Embed Size (px):

TRANSCRIPT

Coinsurance

Cost Sharing Policies

• Service benefit policies use three cost-sharing features, sometimes in concert: the deductible, the coinsurance rate, cost caps and the stop loss amount

Deductible

• The deductible is the amount that an individual must pay before the insurance company pays anything.

• The deductible is usually set annually; the typical deductible in 1991 was about $200 for an individual and $500 for a family.

• Consumers pay the full price for care consumed under the deductible.

Page 4: Coinsurance. Cost Sharing Policies Service benefit policies use three cost- sharing features, sometimes in concert: the deductible, the coinsurance rate,

Coinsurance rate

• The coinsurance rate is the percentage of the total bill above the deductible that a patient pays.

• Nearly all indemnity plans had a coinsurance rate of 20 percent.

Page 5: Coinsurance. Cost Sharing Policies Service benefit policies use three cost- sharing features, sometimes in concert: the deductible, the coinsurance rate,

Stop loss

• The coinsurance is paid until the patient reaches the stop loss - the maximum out-of-pocket payment by the person in a year.

• A typical stop loss in an indemnity policy was about $1,000 to $1,500 in a year.

Page 6: Coinsurance. Cost Sharing Policies Service benefit policies use three cost- sharing features, sometimes in concert: the deductible, the coinsurance rate,

Caps

• In addition to these features, many policies impose further cost sharing through caps on various types of expenditures.

• For example, policies may permit 8 mental health visits per year, or have a $1 million lifetime limit on overall medical expenditures.

• Such provisions discourage use

Page 7: Coinsurance. Cost Sharing Policies Service benefit policies use three cost- sharing features, sometimes in concert: the deductible, the coinsurance rate,

Cumulative Individual Payments

Total Payment

Patients Cost

Stop-loss

Deductible Medical Expenditure

Individual Payment

Insurer Payment

Coinsurance

Risk-sharing features of indemnity insurance policies, 1991

Characteristic Average/percent

DeductibleIndividual 205$

Family 475$

Coinsurance rate

<20 percent 13%

20 percent 78%

>20 percent 4%

Stop loss

<500$ 21%

500$ - 1000$ 30%

1000$ - 2000$ 32%

>2000$ 17%

Maximum lifetime benefit - individual

<250,000$ 9%

250,000$ - 1,000,000$ 6%

>1,000,000$ 85%

Page 9: Coinsurance. Cost Sharing Policies Service benefit policies use three cost- sharing features, sometimes in concert: the deductible, the coinsurance rate,

Optimal insurance given moral hazard

Author Optimal policy

Feldstein and Friedman (1977) 58 percent coinsurance rate

Buchanan, Keeler et al. (1991) 200$ deductible;25 percent coinsurance rate

Newhouse et al. (1993) 200$ to $300 deductible;25 percent coinsurance rate;

1,000$ stop loss (assumed)

Manning and Marquis (1996) 25 percent coinsurance rate;>25,000$ stop loss

Blomqvist (1997) Cost sharing declines from 27%at roughly $1,000 of spending to 5%above roughly $30,000

Page 10: Coinsurance. Cost Sharing Policies Service benefit policies use three cost- sharing features, sometimes in concert: the deductible, the coinsurance rate,

Thank You !Any Question ?

Extra Benefits...Diagnostic services: $0 copay Restorative services: 20% Coinsurance Periodontics: 20% Coinsurance Extractions: 20% Coinsurance There is a benefit deductible of $35

1 Administering Security Policies + Data Sharing Arnon Rosenthal The MITRE Corporation

Analyzing fee and free spatial data sharing policies in ... · Analyzing fee and free spatial data sharing policies in public sector in Uganda By Uwayezu Ernest March, 2010 .

Control Policies for HGI Performance in Resource Sharing

Data Sharing Policies The International Polar Year Case - AWI

Coinsurance – The Other Reinsurance

Extra Benefits - AR Health & Wellness...Diagnostic services: $0 copay Restorative services: 20% coinsurance Endodontic services: 20% coinsurance Periodontics: 20% - 50% coinsurance

Overview of policies for security and data sharing

Vilhauer Enterprises...(MRI, MRA, Pet Scans, CT Scans, etc.) 30% coinsurance, after deductible 25% coinsurance, Hospital Services 30% coinsurance, after deductible 25% coinsurance,

Call-On Congress 2012: Coinsurance Webinar #2

Summary of Benefits and Coverage: What this Covers & What ...williamstanklines.com/careers/anthemSBC.pdf20% coinsurance 40% coinsurance -----none-----Specialist visit 20% coinsurance

The Sharing Economy: Perspectives on Policies in the New Economy

Optimal Policies for Information Sharing in Information ... · Optimal Policies for Information Sharing in Information System Security Yueran Zhuo and Senay Solak Isenberg School

Greening Effect of Spatio-Temporal Power Sharing Policies

What is coinsurance? Understanding our Financial Policies · insurance eligibility and benefits and file insurance claims for services provided. It is also the responsibility of the

Data sharing policies and legal framework in fishery and marine sciences

Impact of Spatio-Temporal Power Sharing Policies on ...lanada.kaist.ac.kr/Publication/Conference/Impact... · Impact of Spatio-Temporal Power Sharing Policies on Cellular Network

Interdisciplinary Biomedical Research...BD2K: Four Programmatic Areas Policies • Data Sharing – Genomic data sharing plan update – Data sharing plans on all research awards •

Broadband infrastructure sharing policies and strategies ... broadband for all... · Broadband infrastructure sharing policies and strategies in emerging markets ... power grids,

Data Sharing Policies and Licensing Will Craig University of Minnesota & NSGIC

Summary of Benefits and Coverage - WordPress.com · Specialist visit 20% coinsurance 40% coinsurance None Preventive care/screening/ immunization No charge 40% coinsurance You may

Policy-Enhanced Private Set Intersection: Sharing Information While Enforcing Privacy Policies

ECONOMIC POLICIES TOWARD LESS DEVELOPED COUNTRIES Congress/Economic Policies Toward Less...D. Sharing the aid burden- -_____ 40 How much aid for development assistance?----- 40 Sharing

San Francisco Department of Public Health Minimum Standards a… · OOP Maximum must include all types of cost‐sharing (deductible, copays, coinsurance, etc.). 3. Medical Deductible

Blue-Care€¦ · 01/01/2017 · Cost Sharing Means the applicable Copayment, Coinsurance, that must be paid by the Covered Person for a Covered Service. Cost-Sharing does not include

Different Resource Sharing Policies under a General ...ijcsi.org/papers/IJCSI-9-5-1-126-135.pdf · Different Resource Sharing Policies under a General Channel Management Strategy

NSB-09-20, NSF Cost Sharing Policies for a Robust Federal

Policies promoting Social and Sharing Economies in ......Purpose of the Study • assessment of the impact of social and sharing economy policies on youth unemployment (focus on NEETs

Data Management and Sharing Policies in the NSF …vcs/talks/ColumbiaPanelSep...Data Management and Sharing Policies in the NSF and the NIH Victoria Stodden Department of Statistics

Performance Evaluation of Load Sharing Policies with PANTS on a Beowulf Cluster

BIKE-SHARING SYSTEMS: PARKING RESERVATION POLICIES

Investing in the Future: NSF Cost Sharing Policies for a Robust … · 2015-09-15 · Investing in the Future: NSF Cost Sharing Policies . for a Robust Federal Research Enterprise

Establishing Effective Security Policies BJA Regional Information Sharing Conference

PowerPoint PresentationD750D8EC... · under the Affordable Care Act. Coinsurance – or cost sharing is the percentage you pay for certain services based of the allowed amount charged

NIH Wide Policies on Sharing of Data - Genome.gov · Existing Data Sharing Policies The existing NIH-wide policy targets wide sharing of data in projects with direct costs exceeding