Patient Statement Guide

A copay, or copayment, is a predetermined rate you pay for health care services at the time of care. For example, you may have a $25 copay every time you see your primary care physician, a $10 copay for each monthly medication, and a $250 copay for an emergency room visit.

Coinsurance is a percentage of a medical charge you pay, with the rest paid by your health insurance plan, which typically applies after your deductible has been met. For example, if you have 20% coinsurance, you pay 20% of each medical bill, and your health insurance will cover 80%.

COPAYS VS COINSURANCE:

The deductible is how much you pay before your health insurance starts to cover a larger portion of your bills. In general, if you have a $1,000 deductible, you must pay $1,000 for your care out of pocket before your insurer starts covering a higher portion of costs. The deductible resets yearly.

Copay vs. deductible 

Your health plan may have both copays and deductibles, and whether you pay one or the other may depend on the services you receive. For some services, such as a visit to your primary care doctor, you may owe a fixed copay, such as $10 or $20. For other services, such as an MRI, you may have to pay the approved cost of the service up to your deductible. 

Your copay may count toward your deductible, but it doesn’t always. And you may owe copays for some services after you meet your deductible.