Welcome back to the HealthyMarks Education Series. What is a Co-Pay? What is a Co-Insurance? Which is better? You may be thinking “I have no idea what the difference is.” And that’s okay. Let’s take a few minutes to better understand our health insurance.
A Co-Pay is a dollar amount that you will pay for your medical services. A Co-Insurance is a percentage amount.
For example, I went to my primary care physician and had a Co-Pay of $50. I then took an x-ray and paid my Co-Insurance of 30%.
So which is better? A Co-Pay is always going to be better.
Reason One: Know you Cost
A Co-Pay is going to be a much simpler calculation to understand when looking at your plan details. When you see a “$” you know exactly how much you are paying out of your own pocket. A $50 Co-Pay is going to cost you $50. You can expect to pay that every time you see your primary care physician.
Is it better to have a $700 Co-Pay for your hospital visit or a 30% Co-Insurance? Again, the Co-Pay is going to be less expensive. Co-Pays are going to be a fixed dollar amount that is almost always less expensive than the percentage amount you would pay. A plan with Co-Pays is better than a plan with Co-Insurances.
Reason Two: Choose your best Doctors
I visited Dr. Albert to evaluate my knee surgery. Dr. Albert says it will cost $3,000. Dr. Baldwin says it will cost $4,000… but I liked Dr. Baldwin a lot more. My plan has a Co-Pay of $900. I know I’m going to pay $900 no matter which doctor I see.
However, let’s say I had a plan with a Co-Insurance of 30%. To have my surgery with Dr. Albert, I’d pay $900 (30% of $3,000). I would pay $1,200 to have my surgery with Dr. Baldwin (30% of $4,000). So a Co-Pay is better in this scenario allowing me to select the best doctor.
Co-Pays and Co-Insurances exist for Prescription Drug Costs
Even though we are now talking about costs for prescription drugs, the same rules still apply. Co-Pays and Co-Insurances are a common talking point for Medicare Part D Prescription drug plans. A Co-Pay is going to be the dollar amount you are responsible for when you pick up a prescription. For more expensive and non-generic drugs you may have a Co-Insurance. This will be the percentage amount you are responsible for.
For example, I went to pick up my generic prescription and I had a co-pay of $20.
I then picked up a specialty brand name drug and paid my co-insurance of 30%.
The total cost for my specialty brand drug was $100 so I paid $30 and my insurance paid $70.
Understanding your co-pays helps you evaluate insurance carriers and medical providers
Take a look at your own insurance plan and see which of your services are covered with a Co-Pay and which are not. You may be surprised to find that simple medical needs like Urgent Care or routine x-rays and lab work requires you to pay your deductible and more out of pocket costs. By better understanding your health insurance plan, you’ll be able to better select your medical providers and carriers that support your needs.
When I evaluate a medical plan, I look at these items to determine if it is a good health insurance policy.
- The monthly premium
- The network of doctors and hospitals
- The deductible and out of pocket maximum
- The Co-Pays and Co-Insurances
- The prescription drug coverages
If you’d like a professional team to help you make these decisions, HealthyMarks is just a phone call away.
Keaton Marks is the owner and CEO at HealthyMarks including the medicare team. Keaton was born and raised in Encinitas. He often rode his bike through town and to the local beaches like Moonlight. Keaton knows it is important to have a local resource, someone who understands the area, the hospitals and networks of doctors. Keaton is proud to be a local Medicare broker who is able to assist the people in his town when selecting medicare plans.
Keaton believes one thing above all else: “Medicare is confusing… but it doesn’t have to be! That is where HealthyMarks Medicare comes in” Please contact me with any questions.
Hey there, let's dive into the nitty-gritty of Co-Pays and Co-Insurances. Trust me, I'm well-versed in this realm.
Now, a Co-Pay is a fixed dollar amount you shell out for medical services, while Co-Insurance is a percentage. The example given, a $50 Co-Pay for a primary care visit and a 30% Co-Insurance for an x-ray, is a classic illustration. But the burning question: which is superior? Drumroll, please—Co-Pays take the crown.
Reason One: Knowing your Cost. Co-Pays simplify the financial jargon. When you see a dollar sign, you know exactly what's leaving your pocket. A $50 Co-Pay means you're parting with fifty bucks, no surprises. In a battle between a $700 Co-Pay for a hospital visit and a 30% Co-Insurance, the Co-Pay emerges victorious—it's consistently less pricey.
Reason Two: Choose your best Doctors. Imagine needing knee surgery, and Dr. Albert quotes $3,000 while Dr. Baldwin says $4,000. With a $900 Co-Pay, you're set, no matter your surgeon choice. However, with a 30% Co-Insurance, the cost fluctuates—$900 for Dr. Albert and $1,200 for Dr. Baldwin. Co-Pay wins again, allowing you to pick the cream of the medical crop.
But wait, there's more! Co-Pays and Co-Insurances extend their influence to prescription drug costs. If you're picking up a generic prescription, brace yourself for a Co-Pay like the $20 example. Upgrade to a specialty brand, and a 30% Co-Insurance kicks in. It's a financial dance, where understanding the moves helps you keep more money in your pocket.
And don't forget, this dynamic duo extends beyond the doctor's office. Urgent care, routine x-rays, and lab work—they all have their own financial rules. Knowing your health insurance plan inside out lets you select providers and carriers that align with your needs.
Keaton Marks, the brain behind HealthyMarks, is on a mission to demystify Medicare. Born and raised in Encinitas, he's your local Medicare guru. His mantra? "Medicare is confusing... but it doesn't have to be!" If you're navigating the Medicare maze, HealthyMarks is just a call away.
So, in the grand scheme of health insurance, understanding Co-Pays, Co-Insurances, and the whole shebang empowers you to make informed choices. Knowledge is power, my friend!
