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What is Copay for Health Insurance?

Copay insurance is the fixed amount you are obligated to pay for a covered health care service. Copays are payable at the time you receive a health care service. You will most often be asked to deliver your copay when you check-in for your physician’s visit or diagnostic test. Copay amounts differ depending on your health insurance plan. For instance, some patients will be required to copay $15 for a regular checkup, whereas other patients might have a $20 (or a lower or higher) copay for the same appointment

A deductible is an amount you must pay for a health care service before your health insurance plan starts paying. For instance, if you visit an emergency department and your deductible amount is $500, you must pay the $500 deductible amount before your insurance organization covers your emergency visit’s remaining health care charges. Notably, deductibles do not always apply to all health care services. For this reason and to avoid unwelcome billing surprises, you should ask your insurance company for a list of covered services

Coinsurance refers to your share of expenses of a health care visit. Coinsurance is calculated as a percentage of the amount of services that you receive. You are responsible for paying the entire amount of your coinsurance and your deductible charge. For instance, if your health insurance plan allows $100 for a health care checkup and you have paid your deductible, your coinsurance payment of 20 percent (or whatever percent applies to your insurance plan) would be $20. Your health insurance plan will pay the outstanding $80 due for your visit.

Know Your Benefits

Now more than ever, ongoing changes with health insurance programs make it particularly important to understand your coverage and know the expenses you must pay when visiting your physician, having tests, and undergoing procedures. For this reason, Health Insurance Plans recommends that you learn the specifics of your health insurance plan before upcoming health care visits.

Your insurance plan may need multiple copays, higher deductibles, and coinsurance. Coverage will depend on the type of health insurance plan that you have chosen.

You can learn the details of your health insurance plan by visiting your insurance company’s Web site or contacting its customer/member services department. The back of your insurance card should include the phone numbers and Web site addresses you will require.

Resources and References:

• Benefits of Health Insurance
• Factors Affecting Cost of Insurance