Both a copay and deductible are types of healthcare expenses, but they are not the same. A copay is a fixed amount that you pay for a particular service, while a deductible is the amount that you have to pay for healthcare services before your insurance coverage begins. Understanding the differences between these two types of expenses can help you make more informed decisions about your healthcare coverage.
What is Copay?
Copay is a health insurance term that refers to the fixed amount that an insured person must pay out-of-pocket for a covered medical service, typically on a periodic basis. copays are usually due at the time of service.
- The insurer pays the remaining portion of the bill after the copay is paid. Copays may be charged for services including office visits, prescriptions, and diagnostic tests. Some insurance plans waive copays for preventive care services.
- Copays are generally much lower than the insured person’s share of the bill for non-preventive care services, which is typically a percentage of the total bill (coinsurance).
- The presence of a copay does not mean that the service is fully covered; there may still be a deductible and/or coinsurance owed. Nor do all plans have copays; some have only deductibles and coinsurance.
The size of the copay may vary by insurance plan and by service received. For example, a plan may have higher copays for brand name drugs than for generic drugs.
What is Deductible?
A deductible is the portion of an insured loss that must be borne by the policyholder before the insurance company will begin to make payments. In other words, the deductible is the amount of money that you, as the policyholder, are responsible for paying in the event of a covered loss.
- Deductibles are common in both property and casualty insurance policies, such as homeowners and auto insurance. Deductibles help to keep premiums low by sharing some of the risk with the policyholder.
- For example, if you have a $500 deductible on your auto insurance policy and you suffer a covered loss that costs $1,000 to repair, you will pay $500 and your insurance company will pay $500.
- Deductibles can be either a fixed dollar amount or a percentage of the covered loss. Deductibles may also apply per-policy period, per-occurrence, or per-person. Deductibles are typically stated in the declarations page of an insurance policy.
Differences between Copay and Deductible
When it comes to health insurance, there are a lot of confusing terms and concepts. Copay and deductible are two such terms. Copay is a fixed amount that you pay for covered medical services, while deductible is the amount you have to pay for covered medical expenses before your insurance company starts to pay.
Both copays and deductibles can vary depending on your specific plan. For example, your plan might have a $20 copay for doctor’s visits and a $250 deductible for hospital stays. In general, plans with higher copays tend to have lower deductibles, and vice versa. It’s important to choose a plan that strikes the right balance for you and your family based on your expected medical needs and budget.
Conclusion
A deductible is the amount you have to pay out-of-pocket for healthcare services before your insurance company begins to pay its share. A copayment (or co-pay) is a fixed amount that you pay for each healthcare service that you receive. In most cases, your insurance plan will have both a deductible and copays. Make sure you understand how these work with respect to your own policy so you can be prepared when it comes time to use your benefits.
