What is the difference between co-pay and a coinsurance?

With any family health insurance or individual health insurance plan you choose, you’ll have certain out-of-pocket costs along with your monthly premium. These expenses may include your annual deductible, copayments, and co-insurance. Although the latter two may sound similar, they are, in fact, two quite different things.

A copayment is a fixed dollar amount you will pay each time you visit your primary care physician, a specialist, receive prescription medication, or have other basic, routine services. This amount generally does not go towards your annual deductible or your out-of-pocket maximum. Copayments tend to be billed at the time of service.

Coinsurance is a percentage of the total cost of your care for which you are responsible. It may range from 10 to 50 percent, and your group health insurance plan will pay the remaining percentage. You will begin to pay your co-insurance amount once you’ve fulfilled your responsibility for your deductible. Your co-insurance amount will count towards your annual out-of-pocket maximum. Your co-insurance may come into play when you are hospitalized, require emergency care, have a surgical procedure, or use out-of-network care.

Generally, you will not be responsible for both the copayment and the co-insurance for the same expense. However, a bill with multiple expenses may have both co-insurance and copayment claims on it. For instance, you may pay a copayment for an office visit that involves lab work and be billed later for the co-insurance portion.

Copayments, co-insurance, annual deductibles, out-of-pocket maximums, and monthly premiums: If it seems as though there are many expenses associated with health insurance plans, it’s important to note there are far more expenses associated with being uninsured. Health care costs continue to rise every year, and those without health insurance tend to delay or skip critical exams and tests, risking their immediate and long-term health as well as their finances.

Health care savings accounts and group health insurance plans can help you save on your insurance costs, as can one of the many affordable health insurance plans customized for your specific needs.

 

 

Source: Health Care Los Angeles

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