Health insurance deductible vs copay is both types of cost sharing in terms of how insurance companies share the cost of your health care with you. So what’s the difference between a deductible and a surcharge? They differ in when you have to pay, how much you have to pay, and what is left to pay for your health plan.
The fact that the surcharge is also part of the plan while running your franchise certainly makes things easier. They will be explained in more detail below, but for now it will be enough to know that they set prices for specific medical procedures.
As for the insurance deductible and its overall importance in choosing the right health plans, you need to understand the relationship between it and the cost of the premium. The lower deductible will start your insurance much faster, but will probably be associated with a higher premium. In addition, the higher deductible will lead to a lower premium – below we will help you understand which one best suits your needs.
What is the difference between deductible vs copay?
- The deductible is a fixed amount that a patient must pay each year before health insurance payments begin to cover costs. Once the deductible is reached, beneficiaries usually pay co-insurance – a percentage of the cost – for any services covered by the plan. They continue to pay co-insurance until they reach the maximum amount for the year.
- Copay is a fixed amount of money set by the insurance plan as a measure of the distribution of costs for certain medical services. Insurance plans are a partnership between a client and an insurance provider to pay for medical services. When purchasing health insurance, it is important to consider cost-sharing measures such as co-payments and co-insurance.
Not every medical service is also related to your deductible. Many preventive services, and in some cases primary care, are provided to the insured free of charge. It depends on the type of coverage, so be sure to check your coverage certificate.
The deductible may also be broken down by individuals or families. Family deductibles may be a single lump sum applicable to the whole family, or each family member covered by the plan may have a separate deductible that goes to the family deductible (ie a family of four may have a family deductible of $ 2,000, which is divided into an individual deductible of $ 500 per member). As a rule, after the deductible you share the cost of medical services with the insurance company. This is called co-insurance.
How does insurance copayment work?
Insurance copayment is a fixed amount that you pay to the provider for the service covered. Surcharges usually vary depending on the service required. For example, a visit to the doctor may have a surcharge of $ 20, which must be paid before the service is provided. The copay for visiting a specialist can be a little higher, from 30 to 50 US dollars. The general rule is that surcharges for regular visits and check-ups are usually lower (eg annual check-ups, mammograms, gynecological check-ups). Exams or treatments that are more specialized (perhaps for a specific condition) tend to have a higher surcharge.
In some cases, the surcharge is paid only after the deductible is repaid. It is also worth noting that many plans cover basic services (annual inspections, preventive inspections, etc.) before the franchise is completed.
ALSO CHECK: What is out-of-pocket maximum?
How does insurance deductible work?
A high-deductible health plan (HDHP) is exactly what it sounds like: a high-deductible plan. These plans usually offer the lowest monthly bonuses. These plans may be attractive to those who want to minimize monthly premium costs or who do not anticipate many health care needs during the year. Also known as “catastrophic health plans”, they are designed to protect people from the worst.
If you have emergency medical care that will cost you tens of thousands of dollars in medical expenses, you can get coverage for any medical services that exceed the deductible. On the other hand, you also usually pay for all the health care costs out of your own pocket until the deductible, which can still be several thousand dollars, is repaid.
Deductible vs Copay | How do they work?
In some plans, certain services are covered by a copay before you receive the deductible, while others have a surcharge only after you cover the deductible. And the rules of co-payment with pre- and post-deductible often differ depending on the type of service you receive. For example, a health plan may include a $ 25 surcharge for visiting your primary care physician from the beginning (ie no deductible is required), but the same plan may include a $ 500 deductible that you must pay before than to start receiving co-paid medication (in other words, you will have to pay the first $ 500 for the cost of the medication, and then you will switch to a co-payment that depends on the level of the drug).
What if my health plan requires me to meet a deductible before copays kick in?
If your health plan requires you to pay a deductible (medical or prescription) before copay, you will have to pay the full cost of your health care until you pay the deductible – albeit at the rate agreed by the network as long as you stay online.
But many health plans apply a deductible to some services and copay to other services from the beginning. Surcharge services often include primary care, specialist visits, emergency care, and prescription drugs. Depending on how your plan is designed, you may receive a surcharge for some or all of these services, whether or not you have paid your deductible. This means that your insurer will be involved in the cost of your service from the beginning of the planning year.
But for other services, usually including labs, x-rays, surgeries, inpatient treatment, etc., you will most likely have to pay a deductible before your insurance plan starts to pay for part of your care (and then you will usually have to pay co-insurance until you reach the maximum amount of own funds for the year).
