Coinsurance and copays: See how they affect your plan
If you’re new to buying your own health insurance or need a refresher, for most health insurance plans, you have to share part of your medical expenses with the insurance company. It’s called cost-sharing, and deductibles, coinsurance and copays are all examples of how you may have to share the bill.
What is coinsurance?
Coinsurance is the percentage of the doctor's bill that you have to pay.
After you have paid your deductible, your insurance company will cover most of your health care costs. You only have to pay for a small portion— the coinsurance.
For example, suppose your plan has 20% coinsurance, you've already paid your deductible, and you need a $10,000 surgery. You would pay a maximum of $2,000 and your insurance would pay the rest.
Quick tips:
If you expect to visit the doctor often or have a chronic condition, you might want to look for a plan with low coinsurance.
Although lower coinsurance generally means higher monthly premiums, you could end up saving money in the long run. You'll pay less each time you need care.
What is a copayment?
A copayment is a flat-fee you pay at the doctor.
You usually pay copayments when you check-in at a doctor's office or get a prescription (unless you're receiving free preventive care services). A copay is often a small amount (like $20 for a typical doctor's visit).
Quick tips:
If you are a freelancer that likes to keep it simple, a flat-fee to see the doctor could be best for you.
Copay plans sometimes cost more per month, but they lower the cost of going to the doctor for a minor issue because you'll know exactly how much you'll have to pay.
Some plans have a low copayment for certain types of care, even if you haven't yet met your deductible. These plans often cost a little bit more, but might be a good choice if you know you'll go to the doctor a few times each year.
