What You Need To Know About:
Co-Pay, Co-Insurance, and Deductible
A co-pay is a fixed amount of money you pay at the time
of receiving medical services. It is a predetermined fee set by your insurance plan. For example, if your co-pay for a doctor’s visit is $20, you would pay that amount directly to the healthcare provider, and your insurance would cover the remaining costs. Co-pays are typically applicable for each visit or service you receive.
Co-insurance refers to the portion of medical costs that you share with your insurance company after you’ve met your deductible. It is usually expressed as a percentage. For instance, if you have a 20%
co-insurance, you would be responsible for paying 20% of the medical expenses, while your insurance company would cover the remaining 80%. This cost-sharing arrangement applies to services covered by your insurance plan, such as hospital stays, surgeries, or specialist visits.
A deductible is the amount of money you need to pay out of your own pocket before your insurance coverage starts kicking in. Let’s say you have a $500 deductible. Before your insurance begins paying for covered services, you would need to personally pay for medical expenses that accumulate up to $500. Once you’ve reached your deductible, your insurance coverage begins, and you would then be responsible for co-pays, co-insurance, or any other cost-sharing requirements specified by your plan.
In summary, a co-pay is a fixed fee you pay per visit or service, co-insurance is the percentage of costs you share with your insurance company after reaching your deductible, and a deductible is the initial amount you pay before your insurance coverage starts. These terms help determine how much you pay for medical care and how costs are split between you and your insurance provider.