Copays vs. Coinsurance: Know the Difference?
November 14, 2023
Health insurance is complicated, but you don't have to figure it out alone. Understanding terms and definitions is important when comparing health insurance plans. When you know more about health insurance, it can be much easier to make the right choice for you and your family.
A common question when it comes to health insurance is, "Who pays for what?" Health insurance plans are very diverse and depending on your plan, you can have different types of cost-sharing: the cost of a medical visit or procedure an insured person shares with their insurance company.
Two common examples of cost-sharing are copayments and coinsurance. You've likely heard both terms, but what are they and how are they different?
Copayments
Copayments (or copays) are typically a fixed dollar amount the insured person pays for their visit or procedure. They are a standard part of many health insurance plans and are usually collected for services like doctor visits or prescription drugs.
For example: You go to the doctor because you are feeling sick. Your insurance policy states that you have a $20 copay for doctor office visits. You pay your $20 copay at the time of service and see the doctor.
Coinsurance
This is typically a percentage of the total cost of a visit or procedure. Like copays, coinsurance is a standard form of cost-sharing found in many insurance plans.
For example: After a fall, you require crutches while you heal. Your coinsurance for durable medical equipment, like crutches, is 20% of the total cost. The crutches cost $50, so your insurance company will pay $40, or 80%, of the total cost. You will be billed $10 for your 20% coinsurance.
Your Home. Your Town. Your Health.
Your Home. Your Town. Your Health.
Understanding the difference between copays and coinsurance is important when comparing health insurance plans. Remember, copays are a fixed dollar amount, and coinsurance is a percentage of the total cost.
Health Insurance Agents
Health insurance is complicated. If you're looking for health insurance coverage for yourself, your family or your employees, you can have a licensed health insurance agent work for you! The National Association of Benefits and Insurance Professionals (NABIP) is a great place to start. You can use their Find an Agent tool that will help you find a reputable health insurance agent in your area.