What is the difference between a copay and a deductible?
A copayment (copay for short) is the fixed amount ($20, for example) that you pay for a covered health care service. The remaining balance that you do not pay the doctor is covered by your insurance company.
A deductible is a fixed amount that you pay during a given time period, usually a year, before the health insurance benefits begin to cover the costs.
The monthly payment you make to an insurance company to buy a policy is the health insurance premium.
Typically, if you have a lower monthly premium for health insurance coverage, your copay and your deduuctible could be higher.
If you have a higher monthly premium, your copay and your deductibles could be lower.
Some healthcare coverage plans will cover routine doctor visits, prescription drugs and preventive care before you meet your deductible.
Unlike a deductible, a copay fee usually is less than $100 and is paid each time you visit a medical provider.
Copays also can be charged for tests, prescription drugs, physical therapy and other covered expenses.
You pay one fee to visit a family practice doctor. Whereas, you may pay a different fee amount to see a specialist or to go to an emergency room or clinic.
According to Kaiser Family Foundation, workers are paying an average of $25 copay for a primary care office visit. An average specialty care office visit is $40.
Close to half of adults who bought their own coverage, along with 43 percent of those with insurance through their employer, said they were surprised by the high cost of their most recent health-care bill in the last year, according to a survey from Bankrate.com.
Deductible amounts vary by plan, but generally are stipulated as a yearly maximum figure.
The deductible renews annually, so each year you will face a fresh deductible, even if you paid the full deductible in the previous year.
For example, if you have a $2,500 deductible, you will have to pay for the first $2,500 of care that you receive each year.
Americans are paying a sizeable amount of expenses before their health insurance coverage kicks in.
High Deductible Plans
The IRS defines a high-deductible health plan as one that has a deductible of at least $1,350 for individual coverage or $2,700 for family coverage.
In reality, high deductible plans can range from $5,000 to $12,000 depending on the type of policy you purchase.
Know how your plan works.
Every plan is different in the way it handles copays and deductibles.
Take some time to discuss your health insurance coverage options by phone or schedule a webinar with a licensed insurance expert. Review the exact benefits available so you can ask questions.
Call 281.979.5441 or contact us via email to setup a day/time that’s convenient for you to discuss your current health insurance coverage, including your copayment and deductible amounts!
It may be the most informative 2-3 minutes of your life.