Visiting your doctor’s office? You’ll likely pay a copay.
If you’ve had health insurance for any amount of time, you’ve likely paid a copay. Knowing how these copays work can help you pick the best insurance plan for you or your family. In fact, it might even help you save money on your health care.
What Is a Copay for Health Insurance?
A copay (or copayment) is a set fee that you pay for a healthcare service under certain insurance plans. For example, your plan may have you pay a $20 copay for a basic doctor’s visit. Simple enough, right?
It does get a little more nuanced. To understand copays, you need to understand deductibles. A deductible is the amount of money you pay for healthcare services before your insurance kicks in. Whether or not you pay a copay or the full price of the service may depend on whether you have met your deductible.
How It Works
Let’s say you need an MRI. At full price, these could cost hundreds or thousands of dollars. If you haven’t met your deductible yet, you’ll likely need to pay full price. If you have met your deductible, you’ll likely only need to pay a copay, which might be as low as $20. Finally, if your deductible is lower than the price of the MRI, you'll pay the deductible (and likely a copay), as opposed to the full price.
One exception: For some healthcare services, you’ll only ever need to pay a copay—whether you’ve met your deductible or not. For example, many insurance plans offer certain services (especially preventative services) for a small copay. This includes doctor visits, annual checkups, cancer screenings, and dental cleanings.
Why? This is usually to make sure you can afford preventative services and basic care. These services may help prevent major health problems or catch them early. Health problems often get harder (and more expensive) to treat as they progress, so catching issues early is very valuable. It can help both you and the insurance company save money.
Knowing How Much You’ll Pay
When picking a plan, the health insurance company will usually give you a breakdown of how much you can expect to pay for various services. For example, it should tell you the copay for visiting a primary care doctor, visiting a specialist, or visiting an urgent care center. Plus, it should tell you which services require that you meet your deductible first, or if you only need to pay a copay regardless.
To avoid any surprise payments, it’s always a good idea to do your research before you seek a healthcare service (if it’s not an emergency). You can often find this information in the brochure for your health insurance plan. However, if you’re confused, it may help to speak to a representative for your insurance plan.
The price of your copays will also vary depending on the plan you choose. For example, plans that have higher premiums (monthly fees) sometimes have lower copays. Sometimes people choose high-premium, low-copay plans if they know they will be visiting the doctor’s office frequently. On the other hand, a low-premium, high-copay plan might work well for someone who doesn’t anticipate visiting the doctor often.
If you have more questions about copays and how they affect your overall healthcare costs, talk to a representative for the insurance company. They can answer your questions based on your unique details, so you’ll be more confident making the most of your insurance plan.