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What is a copay health insurance policy?

many people looking for a copay health insurance policyA copay health insurance policy is one where the insured individual pays a specific amount of out-of-pocket expenses for health care services such as:

  • Routine doctor visits
  • Laboratory fees
  • Prescription drugs

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These are generally the only costs incurred by the insured. Insurance companies use copays to share the costs of your health care. A copay feature may be a part of another type of insurance policy as well.

How does copay health insurance work?

The insured person makes payments directly to the service provider, the doctor for example, when the service is rendered, and the insurer pays the balance. The provider often bills the insurance company directly on behalf of the insured, although sometimes patients will receive a bill from the doctor and must pay this for themselves.

There are generally different copays for different services; a visit to a general practitioner usually costs less than a visit to a specialist. Ask your insurance company for a complete schedule of upfront payments due for various services to avoid confusion. These fees are often printed on your insurance card along with your policy number and other important information.

Changes to the law are worth keeping track of; recently the United States Government ruled that health insurance providers can no longer charge for birth control pills and other related services beginning in 2012.

Are copay insurance plans rated by reputable agencies?

Yes, and you can read some plan ratings done by various state governments linked at Consumer Health Rating’s web site. All Medicare approved health plans are rated and be viewed at their website. The National Committee for Quality Assurance (NCQA) also has health insurance plan rankings at their site.

What are the benefits of copay insurance?

Under many insurance plans, you are free to choose your own doctor and hospital. If you are a member of a health maintenance organization known as a preferred provider organization (PPO), you usually don’t need your primary care physician’s referral for specialists. You will have a broad network of providers to choose from and often will enjoy lower copay amounts. Other types of managed plans may require you to see your primary care physician first.

Most copay insurance plans will usually include prescription drug benefits. Be aware that the costs for generic drugs are often less than brand name drugs; check with your doctor to see if a generic prescription will work for you.

They offer a level of certainty in costs. In an effort to encourage healthy behavior, some plans waive the copay for preventative care services. A deductible may not apply to the cost of routine services, be sure to check your policy for specifics.

What are the limitations of copay insurance?

Fees for health care services are generally higher than those for a coinsurance policy. For this reason, many people avoid or put off some doctor’s visits due to the higher cost. Copays do not always count against the deductible limit if there is one. Check your plan carefully for details that apply to you.

Some policies that have copays for doctors’ visits may also have one for visits by your doctor while you are admitted to a hospital. You may have to provide proof of these hospital visits by your doctor to qualify for these benefits. Copay amounts may be higher for out of network health care services you receive.

Is copay insurance the same as coinsurance?

Copay health insurance plans differ from coinsurance where the insured pays a certain percentage of the covered costs. These plans feature set fees, such as a dollar amount that must be paid for some services. Many health insurance plans have features in common; and copays are a common addition to many policies.

Do copay plans have deductibles?

All plans are different and some have a deductible feature. You should read the Explanation of Benefits (EOB) in your policy to see what deductibles might apply to you and in what circumstances.

Is assistance available with copays?

There are programs that provide financial assistance for health care costs to people who qualify.

A listing of these can be found at the Partnership for Prescription Assistance’s website.

To find health insurance quotes online, simply type your zip code into the box on this page to compare rates now!

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One Review

  • UGH. Health insurance has to be the most frustrating thing in the world.Hearing stories from other parts of the country makes me thank my lucky stars every day that I live in Massachusetts.

    Back in 2006, I had a head MRI, 2 CT scans and retina surgery (all unrelated). Total cost: $0. The only charges were co-pays for follow-ups. And that’s when I had a run of the mill local HMO! (Not the fancy-pants PPO I have now.) It’s probably the #1 reason we will never leave this town.

    So while I can’t complain about procedure expenses, my tip: mail order prescriptions. I used to spend $30 a month at CVS for daily medications. Now I get a 3-month supply for $10 through Express-Scripts.com, and only spend $40 a year! Amazing/ridiculous.

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