What the heck is a health insurance co-pay?

January 11, 2016

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Understanding co-pays

A co-pay is a fixed dollar amount (for example, $20), set by your insurance plan, that you pay for healthcare costs, including doctors visits and prescriptions. Your plan may have different amounts for different kinds of health expenses, like primary care visits, specialist care visits or brand or generic prescriptions. You can see your co-pay amount on your insurance plan details.

Co-pays are different from coinsurance in that coinsurance is a fixed percentage that you’ll have to pay for medical services (ex. 20% you/ 80% insurance provider).

Common examples of co-payments

-You go to the doctor’s office because you have the flu. Your mom kept telling you to get that flu shot, but you never did. So much for being invincible. The visit to your doctor costs you $35. This is your designated co-pay for doctor visits.

-The doctor gives you a prescription for generic Z-pack to combat the flu you have. The generic Z-pack costs you $10- this is your designated co-pay for generic prescriptions.

-Say you coughed so hard while having the flu that you threw out your back (man, you have some tough luck). You decide that you need to go the chiropractor. This visit costs you $70- this is your designated co-pay for specialists like a chiropractor.

Co-pays are unique to each plan. It’s best to check your insurance plan details to see what your different co-pays are- that way you won’t have sticker shock when you see your doctor or pick up your pills.