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HealthyAssurance by petMD

Healthy Assurance's mission is simple: To provide pet owners with unbiased, reliable, helpful, and timely information on pet insurance from a veterinarian’s perspective. And what better veterinarian to write this blog than Dr. Kenney, a small animal practioner and author of Your Guide to Understanding Pet Health Insurance

What is the Coinsurance Percentage?

For the past couple of weeks, we have looked at several terms you need to be familiar with and the part they play in determining how much reimbursement you receive from the pet insurance company.
 

First, we looked at lifetime, annual, and per-incident maximums. Last week, we looked at annual vs. per-incident deductibles. This week, we’ll look at the coinsurance percentage.

I realized as I was writing this post that what I’ve always called "copay," as it pertains to pet insurance, is nowadays mostly referred to as "coinsurance."

In human health insurance policies the copay is a flat fee you pay out-of-pocket (e.g., $20 for an office visit or $100 for an emergency room visit). Using this definition, pet insurance policies don’t have a true copay like human health insurance policies. So, in the future, I’ll try to use the term co-insurance.

Hopefully, you aren’t thoroughly confused by now!

Coinsurance is the percentage of the total bill after the deductible that the pet owner is responsible for. This will usually range from 0-40 percent. If a pet insurance company advertizes that they pay 80 percent of the bill after the deductible, it means that the coinsurance, or the amount you pay, is 20 percent of the bill. Some companies will subtract the coinsurance before subtracting the deductible.

Notice the difference the coinsurance percentage can make in how much you have to pay out-of-pocket.



As you can see in the illustration above, the coinsurance percentage is something that you want to keep low, since it varies depending on the size of the claim. In contrast, the deductible is a fixed, known amount regardless of the total bill. As with deductibles, the lower the coinsurance, the higher the premium will be.

I went to the websites of two of the companies that allow you to select your own deductible and coinsurance and obtained a quote. I learned that the deductible had a bigger impact on the premium than did the coinsurance percentage. I could readily see the impact that each possible deductible and coinsurance combination had on the premium when obtaining a quote. Therefore, if you need a lower premium, it is generally wiser to select a higher deductible (especially if it is an annual deductible) and a lower coinsurance percentage.

For the last three weeks, we have looked at annual and per-incident maximums, annual and per-incident deductibles, and coinsurance percentages in isolation and their impact on your out-of-pocket expenses. However, you should also include the premium in the mix to get a truly accurate calculation of your total out-of-pocket expense. 

In a future post, I’ll show you how to evaluate a company’s policies to determine which one is the best buy when taking all these variables into account — including the premium. Sometimes the result will surprise you.

Dr. Doug Kenney

 

Pic of the day: poor lukie by ayako

Cat in the hospital, cat in cone, cat at vet, injured cat

 

Comments  6

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  • How do you feel when
    07/07/2011 02:11am

    So today I received a letter from my Pet Insurance that for whatever reasons I am now dropped down from 80% to 60%....and maybe just maybe if my doggie is "good" for 6 months (or more) they might review her status and put her back up there.

    Unfortunately knowing the track record of my dog, she'll probably be put down to 50% at the next review.

    So is Pet Insurance still good? Still paying 75.00 per month.

    Now my other dog had to have the insurance changed(to a new insurance company) and his skin conditions are now of course pre-existing so I will have to pay out of pocket. They are also including all those fatty tumors as well. However if they remove all those fatty tumors and they don't grow back for a year, they will reconsider and take that condition off.
    Unfortunately a couple grew back so that was the end of that.
    Now...if one of those fatty tumors becomes cancerous, then I am not covered. I am covered for cancer though. Wow

    So what do I do...keep removing all they lipomas - Vet says to just leave it if the dog is not being bothered or if it is not invasive.

    Because I am such an (honest and good customer) my vet lets me pay off or gives me a discount for non insurable "items" - otherwise even with insurance, I'm draining my bank account -

  • 07/07/2011 08:17am

    luvgoldens,

    I am curious about two things after reading your post:

    1) What company increased your coinsurance percentage? I know of only one or two companies that will do this and/or they will raise your premium at renewal based on claim experience. This means if you file a number of claims that they deem excessive, they will make you pay more out-of-pocket in future years. Pet owners need to ask about this before they purchase a policy.

    2) Why did you switch pet insurance companies with your other dog?

    Certain dogs can be "lipoma factories" as I like to call them. It seems several new ones show up every year. As long as your veterinarian has done an aspirate and confirmed the lump as a lipoma, I agree that as long as it doesn't get significantly larger or bother the dog, it should be safe to not remove them.

    It does sound like you did get a medical records review when you switched insurance companies. This was a very smart thing to do. How pet owners can do this when switching companies was covered in a previous discussion.

  • 07/08/2011 01:55am

    1) Yes it's Petsecure
    2) I can't remember exactly what happened but the first year Purina Pet Care came out; it was fantastic policy, then after the first year I got a letter, everything changed; so many changes and they blamed it on people abusing it. They would sign on for a year, use the free yearly examination, heartworm etc. and quit. So everyone ended up getting penalized.
    3) Yes Vet did say it was lipoma and it was aspirated and yes my dog is a "lipoma factory" He is 10 now. My other dog is 3; she is the one that is now 60% - In the first 3 years of her life it seemed for one reason or another I practically lived at my vet:) I am happy I do have insurance.

  • Good Info
    07/07/2011 07:08am

    Thanks, Dr. Kenney. Once again, this is excellent information.

    Unlike insurance provided by an employer where we have no choice, we need to be experts in pet insurance!

  • 07/07/2011 08:27am

    TheOldBroad,

    If I can accomplish only one thing by writing this blog every week, it would be to convince pet owners that pet insurance is a complex subject and learning as many details as possible before signing on the bottom line is worth the effort to avoid future regrets and/or surprises.

    There are no shortcuts to making a wise decision when it comes to choosing the best company and policy for your pet.

  • Re:
    01/25/2012 10:49am

    I am always investigating online for tips that can benefit me. Thanks.

 

 

About Healthy Assurance

  • Dr Kenney, DVM
    Lisa Radosta, DVM, DACVB

    Doug Kenney practices small animal medicine and surgery at Houston Levee Animal Hospital in Cordova, Tennessee. He has a special interest in wellness care...

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