Coinsurance Explained - And Why We Say No |
Milwaukee County Executive Chris Abele wants transit workers to accept “coinsurance” instead of the health insurance they now have.
This would mean much higher out-of-pocket costs for transit workers – thousands of dollars more per year for some, especially single parents and other families.
And there's evidence that these types of high-deductible healthcare plans also result in lower-quality care.
What health insurance do transit workers have now?
The current healthcare plan for most Milwaukee County Transit System employees requires them to pay a deductible, a set fee for services like doctor visits, prescriptions and hospital services. The worker's insurance pays the rest of the actual cost.
For example, the current deductible for a worker's regular doctor visit is $30.
The worker pays the deductibles until an annual out-of-pocket maximum is reached. Then the insurance pays 100 percent of healthcare costs for the rest of the year. Under the current system, the out-of-pocket maximum is:
What changes does Abele want?
Under the current contract offer, workers would be switched to coinsurance, which would require them to pay 20 percent of all healthcare costs AFTER they reach their annual deductible. They'd continue to pay 20 percent until they reached their out-of-pocket maximum, which would be MUCH higher:
Remember, these are the out-of-pocket expenses for every calendar year. If a family has a serious health issue that starts late in the year and extends into the new year, they would be on the hook for $12,000 in only a few short months.
For more details:
What Is Coinsurance? Nine Mysteries Of Health Insurance—Solved
by the Black Women's Health Imperative
Copay vs. Coinsurance: The Differences and Why They Matter
by Lacie Glover, insurance specialist, Nerdwallet.com
This would mean much higher out-of-pocket costs for transit workers – thousands of dollars more per year for some, especially single parents and other families.
And there's evidence that these types of high-deductible healthcare plans also result in lower-quality care.
What health insurance do transit workers have now?
The current healthcare plan for most Milwaukee County Transit System employees requires them to pay a deductible, a set fee for services like doctor visits, prescriptions and hospital services. The worker's insurance pays the rest of the actual cost.
For example, the current deductible for a worker's regular doctor visit is $30.
The worker pays the deductibles until an annual out-of-pocket maximum is reached. Then the insurance pays 100 percent of healthcare costs for the rest of the year. Under the current system, the out-of-pocket maximum is:
- $750 for a single employee.
- $1,500 for a family of two (single parent with one child or a worker and spouse, for example).
- $2,250 for a family of three.
What changes does Abele want?
Under the current contract offer, workers would be switched to coinsurance, which would require them to pay 20 percent of all healthcare costs AFTER they reach their annual deductible. They'd continue to pay 20 percent until they reached their out-of-pocket maximum, which would be MUCH higher:
- $2,000 for a single employee – $1,250 more a year.
- $4,000 for a family of two – $2,500 more a year.
- $6,000 for a family of three – $3,750 more a year.
Remember, these are the out-of-pocket expenses for every calendar year. If a family has a serious health issue that starts late in the year and extends into the new year, they would be on the hook for $12,000 in only a few short months.
For more details:
What Is Coinsurance? Nine Mysteries Of Health Insurance—Solved
by the Black Women's Health Imperative
Copay vs. Coinsurance: The Differences and Why They Matter
by Lacie Glover, insurance specialist, Nerdwallet.com
