When a plan says a service is 'covered,' it doesn't mean you pay nothing. It means the service is eligible for insurance — but you still pay deductibles, copays, and coinsurance. This distinction matters.
Key Takeaways
- 'Covered' means eligible for insurance, not free
- You still pay deductibles, copays, and coinsurance for covered services
- Some services are 'covered at 100%' with no cost-sharing (like preventive care)
- Not covered = you pay the full negotiated rate
Covered vs. Paid For
If a service is 'covered,' your insurance will process the claim. But you still owe your deductible, copay, or coinsurance. Only preventive care is usually covered at 100% with no cost-sharing.
What You Actually Pay for Covered Services
1. If you haven't met your deductible: you pay the full negotiated rate. 2. After you meet your deductible: you pay copays or coinsurance. 3. Once you hit your out-of-pocket max: insurance pays 100%.
Not Covered = You Pay Everything
If a service isn't covered, insurance won't pay anything — you pay the provider's full charge (not the negotiated rate). This is much more expensive.
Common Questions
Frequently Asked Questions
Why do I have a bill if the service was covered?
What does 'covered at 100%' mean?
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