2. The Deductible Status - Every EOB has a column that gives you the status of your deductible. By looking at your previous EOBs, you can determine whether you used all or just a portion of your deductible during the previous year. By knowing how much deductible you used the previous year, you may be able to change your deductible for the coming year. Usually if you increase your deductible, you will pay lower premiums.
3. Co-Pay - The EOB will have a column that indicates what the co-pay is for each medical service you receive. For instance, every time you visit the doctor or pay for a prescription drug, you are charged a co-pay. For doctor visits, this is usually $20 per visit. For prescription drugs, the co-pay varies between $10 and $50 per drug. This may be important if you need prescription drugs for chronic conditions or diagnostic testing services that usually require a higher co-pay.
4. Co-Insurance - The EOB will have a column that tells you if co-insurance has been applied to a medical service you have received. Co-insurance is the percentage of a medical claim your insurer pays after applying the co-pay and the deductible. Most insurance policies pay 80% to 90% of each claim after the co-pay and deductible is applied, leaving you to pay 10%. You need to know what services have co-insurance (many X-rays, CT scans, MRIs, and out-patient procedures have co-insurance) to estimate your future medical expenses. If co-insurance applies to a particular medical service you will need, take this into account when estimating your future costs.
5. Total Patient Responsibility - The EOB will contain a column or category that states all of the costs for medical services not paid for by the health insurer. This is the amount you must pay out-of-pocket for the medical services. If you add your co-pay to the amount listed in the Total Patient Responsibility column, you can determine the exact amount you paid for a particular service, and use that amount to estimate your future out-of-pocket expenses.
Using the table above, or better yet, your own EOBs, you can get an accurate estimate of your future medical expenses. In our next column, we will show you how to use your estimated expenses to find a co-pay, deductible, and co-insurance that fits the most cost effective premium for you, and the health insurance that best fits your needs.
