Chelsey Tucker graduated with a Bachelor of History degree from Metropolitan State University in 2019. She now writes about insurance with her specialty being life insurance and has been quoted on Help Smart Phone and MEL Magazine.

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Dan Walker graduated with a BS in Administrative Management in 2005 and has been working in his family’s insurance agency, FCI Agency, for 15 years. He is licensed as an agent to write property and casualty insurance, including home, auto, umbrella, and dwelling fire insurance. He’s also been featured on sites like

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Reviewed by Daniel Walker
Licensed Auto Insurance Agent

UPDATED: Mar 19, 2020

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A copay is a fee that you have to pay when you have any medical services for which your insurance company is billed and that do not apply to your deductible. The amount of your copay will depend on a number of factors.

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Who your insurance carrier is, what type of coverage you have and what agreement you have made with your insurance carrier will al make a difference.

Sometimes a copay is also called coinsurance because coinsurance refers to a percentage of each service that a patient has to pay.

How Your Copay is Determined

The way your copay is determined depends on the type of insurance that you have. If you have group insurance, for example, then in all likelihood you will not be able to choose what type of insurance you get or what your copays will be. The reason for this is that with a group plan, it is your employer that negotiates with the insurance company for level of health insurance being provided to the employees.

This is not to say that this is the only way that group health insurance works. There are some companies that pay a certain amount for their employee’s coverage and allow them to choose the type of coverage that they want, including their copays. In the past there were quite a few companies that provided this option, but less do so now because the company has to pay the insurance company directly in order to qualify for a group plan and the paperwork can be quite excessive.

If you choose private insurance, then there are a great many things that you have control over such as your copay, deductible, coverage limits and so on. The copay is usually a flat fee, such as $10, $20, $25, etc. In some cases, the copay can vary depending on the service received.

For example, if you were to visit the emergency room, your copay might be $100 while a regular doctors visit is $25 and a physical is $50. All of this will be clearly stated in your health insurance agreement.

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In some cases, your copay will be a percentage of the total cost of a doctor or hospital visit. For example, you may have to pay 20% for each doctor’s visit that you have, each hospital visit and so on. The difference with this type of copay is that once your annual out of pocket maximums are met (deductible) then you don’t have to pay anything for your doctor or to the hospital if the need arises. This ensures that the costs don’t get out of hand should an emergency occur.

The truth is, there can be any number of ways a copay works, such as a combination percentage and then a copay. In this instance, you will pay a certain percentage of the costs and once your deductible is met, you only pay a static copay amount.

The bottom line is that you have full control over what you pay out of pocket when you visit your doctor and because you choose, there should not be surprises when you visit your doctor or the hospital for the first time.

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The Benefits of Having a Copay

If you are wondering what the point is of a copay, the truth is that it will save you money on your monthly premiums. The higher your copay, the more money you are going to save on your health insurance rates.

The catch is, you have to be able to afford the out of pocket payments for every doctor or hospital visit that you make and, unlike other fees you may encounter for your healthcare needs, your copay does not apply to your deductible, this is an expense that continues even if you have to visit your doctor everyday for something. If your deductible is $75 or $100, you could conceivably end up paying a lot of money. The key is to make sure that it’s affordable.

In many cases, you can avoid the process of filing claims with your insurance company if you have a copay as well. What this means is that often an insurance company prefers that their clients file claims instead of the doctors office.

This isn’t a requirement, however, and often a copay is used to cover the administrative costs in a doctor’s office so that they file the claims for you and get paid directly. This can not only save you time, but money as well. Many people struggle with filing claims correctly and having a professional do it take a lot of the burden off of them.

Choosing the Best Health Care Plan

Choosing the right health care plan is pretty important. If you choose one without the right features, you could be stuck with big medical bills and no way to pay. There are many companies out there selling bargain basement health plans at bargain basement prices. The truth is that you get what you pay for. This doesn’t mean that you have to spend your life’s savings on health insurance; on the contrary, there are many affordable options.

If you are searching for health insurance, however, and you see a company that has a much lower price than anyone else does, you need to do a direct apples to apples comparison. Check things like your deductible amount (a very high deductible will yield very affordable premiums), copay, Rx coverage, how many doctor’s visits it covers (some only actually cover 2 visits a year, except for inoculation visits, which means that all other visits would have to be paid for out of pocket), whether it covers long term care and so on.

Only through a side-by-side comparison can you be sure that you are truly getting the coverage that you expect. You don’t have to scour the Internet searching for quotes for your health insurance. Instead, you should use our free quote tool and manage everything from one place. This allows you to see for yourself what insurance companies will charge for the type of coverage that you need.

Having health insurance is important, it ensures that if something serious happens you won’t end up financially ruined as you attempt to pay back thousands of dollars to the doctors and/or hospitals involved in your treatment. Since saving money is important too, using a quote tool ensures that you get the lowest rate.

Our free quote tool is fast and easy to use, it is unbiased in its results, (we aren’t investors in any of these companies, we just want you to get the best insurance rates), so you can be sure that you get the results from your best options, not simply from a handful of companies we like to do business with.

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