Copays
A copay is a monetary charge that your health insurance plan may require you to the pay in order to receive a specific medical service or supply. Copays vary by policy and can change depending on the type of visit.
For example: Let's say Gary goes to a Children’s Colorado specialist with a case of mono. His specialist reviews his insurance and sees that he has a $25 co-pay based on his insurance benefits. His copay is collected, and his insurance company will reimburse the specialist for the difference between the copay and the cost of treatment.
Here's another example: Say your plan’s deductible is $2,500, your plan covers 70% of services and your out-of-pocket max is $7,350. Setting aside copays, here’s what your year looks like:
Deductibles
Your deductible is the amount of your medical costs that you have to pay before your health insurance will pay benefits consistent with the benefit plan.
Example: Gary has a health plan with a $1,500 deductible. If Gary only has minor health expenses during the year that cost less than $1,500 total, he's going to pay the full amount to treat them. However, if Gary has a serious illness that requires a lot of medical care, he'll pay his $1,500 deductible and then his health insurance will pay benefits consistent with the benefit plan.
Coinsurance
Coinsurance is the way you and your health insurance company share the costs of your care. For example, if Gary is injured and he’s met his deductible for the year, his health plan will pay 80% of the cost of his bills, leaving him responsible for the remaining 20%.
So, in summary:
- You pay copays when you see the doctor.
- Deductibles are the portion you must pay before your insurance pays.
- Coinsurance is how you and your insurance company split up the cost of your care.
