Coinsurance
The percentage-sharing provision requiring the insured to pay a stated portion (commonly 20 percent) of covered expenses after the deductible, capping the insurer's exposure and encouraging economical use.
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Practice This Concept
Within a Medicare Part A benefit period, the beneficiary must pay a daily coinsurance amount for inpatient hospital days:
61 through 90, after which the 60 lifetime reserve days may be used — Within a benefit period, Part A covers up to 90 days of inpatient hospitalization: the beneficiary pays a single inpatient deductible covering the first 60 days, then a daily copayment for days 61 through 90, and may then draw on a lifetime pool of 60 reserve days for stays beyond day 90. Once a reserve day is used, it is not replenished, and after the reserve is exhausted the beneficiary has no cap on inpatient cost-sharing. The 61-90 copay structure and the 60-day reserve are signature Part A cost-sharing numbers the exam tests together.
National insurance concept
A consumer whose household income is between 138% and 250% of the federal poverty level may qualify for cost-sharing reductions (CSR) that lower deductibles, copayments, and coinsurance. To receive these reductions, the consumer must enroll in:
A Silver-level plan — Cost-sharing reductions (CSRs) lower the deductibles, copayments, and coinsurance a consumer must pay, but they are available only to enrollees who select a Silver-level plan on the exchange. Eligibility is based on household income between 138% and 250% of the federal poverty level. The benefit is delivered by reducing the plan's cost sharing beyond what the silver metal tier would normally require. Because the plan must be a Silver plan and income must fall within the band, a Bronze, Platinum, or catastrophic plan does not qualify for CSR.
National insurance concept
- Medical ExpenseWithin a Medicare Part A benefit period, the beneficiary must pay a daily coinsurance a…
- Medical ExpenseA consumer whose household income is between 138% and 250% of the federal poverty level…
- Medical ExpenseWithin a Medicare Part A benefit period, for hospital days 61 through 90, the beneficia…
- Medical ExpenseUnder PPACA, cost-sharing reductions (CSR) that lower deductibles and copays are availa…
- Medical ExpenseWhich statement about Medigap Plan A is correct?
- Medical ExpenseAn individual medical expense policy that pays the insured the actual covered charges i…
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