![]() If the health insurance plan’s allowable amount for this office visit is $100 and the copay is $20. Here’s an example of how co-pays work: A patient visits his/her primary care physician. Primary care office visits and specialist visitsĬopays differ among health plans and this fixed fee is usually paid before deductible has been reached. ![]() ![]() The common medical services that may require copays are: Copays can vary for different services within the same plan. The health insurance company will pay part of this cost and the patient will pay the rest. What is a Copay?Ī copay or copayment is the fixed dollar amount that the patient pays a healthcare provider at the appointment. The secondary payer would be responsible for the remaining costs such as copays and coinsurance. If a patient has Medicare as primary insurance as well as secondary insurance, Medicare would cover most of the healthcare bills first. With coinsurance, the patient must pay the deductible before the insurance plan will cover its 80% share of the medical costs. If the coinsurance is 20%, the patient would owe $40 at the time of service.īoth coinsurance and copayment are cost-sharing provisions, but copays require the patient to pay a set dollar amount at the time of the service. Suppose the insurance plan’s allowed amount for an office visit is $200 and the patient has already met his or her deductible. For example, if a health plan has an 80% / 20% coinsurance, this means that the insurer will pay 80% of the allowed health care expenses and the patient will pay 20%, which is the rest of the allowed amount.Ĭoinsurance amounts will vary from visit to visit based on the type of services that the patient receives. What is Coinsurance?Ĭoinsurance is the percentage of the medical expense the insured person and the insurer each pay for services covered by the plan.
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