What is a Health Insurance Copay and How Does it Work?

A health insurance co-pay (copayment) is a set dollar amount you pay for a procedure or office visit (look at your plan summary very carefully). A co-pay is helpful because you’ll GENERALLY pay just the co-pay (unless other procedures are billed by your doctor in addition to the co-pay). For example, let’s say you see your family doctor for a sore throat. If your plan has a co-pay of $35 dollars, you’d pay the $35.

Sometimes you can be billed more than just a co-pay. For example, let’s say you went to a specialist (specialist co-pays are generally more than a primary care doctor) to have a spot on your skin looked at.

The office co-pay may be $75 meaning you would pay that much for the office visit. But if the doctor wanted to remove the spot, he could charge you/your insurance company for a “procedure” that is charged in addition to the co-pay. That would be two charges in one visit. So, the procedure could be billed to your insurance company, and you’d pay whatever your insurance company had negotiated with the doctor for that procedure, and that out-of-pocket cost would apply towards your deductible, and the co-pay would apply towards your “out-of-pocket maximum” (the absolute most you’d pay in any calendar year).

In most cases for surgery, most plans will not have a co-pay, but will have a deductible. So, there won’t generally be a co-pay, but before your procedure, you may be asked by the doctor’s office or surgical center or hospital to pay a certain dollar amount. This amount will come off your deductible amount. So, co-pays and deductibles are different, but anything you do pay, whether it’s a co-pay or deductible all applies in one way or the other towards your “out-of-pocket maximum”.

Getting Started With Nevada Insurance Enrollment

While this is a generalization on how most plans work, it’s important to know how your plan works specifically. Navigating through the many options of insurance can be confusing but speaking with a locally licensed insurance agent will help you to obtain the right coverage you need. You’ll have the peace of mind knowing that you are adequately insured when life complications arise. We work hard to find the most competitive quotes, and best coverage for your needs. Contact us today to begin the process of finding the best insurance plan for your family.