Your deductible and copay are very important aspects of your health plan that will impact how much you pay for your healthcare. It can be confusing at first, so understanding the basics of your insurance plan will help you shop for policies, compare coverage, and ultimately choose the plan that’s right for you.
What is a Deductible?
The deductible is the amount you will have to pay before your health insurance begins to share the expense with you. For example, a $3,000 deductible means that you will need to pay up to $3000 out-of-pocket for your healthcare before your insurance covers your costs. Most healthcare plans will include routine services which won’t apply to your deductible. You will likely just pay a copay for checkups or other preventive care (more on that later).
Some health insurance plans allow for out-of-network care, but your deductible will likely be lower when using in-network doctors or hospitals. A family health insurance plan will also have a different deductible than an individual, so let us help you decipher your options.
How Your Deductible Will Impact Your Premium
The higher your deductible, the lower your monthly payment will be. This can be a way for people in good health to save money, but it can be risky. If you get sick or need surgery while your deductible is high, then you will incur expensive medical bills up to that amount.
People with medical conditions that require frequent doctor’s appointments or treatments may benefit from a plan with a low deductible. Even though the premium is higher, health insurance will cover a higher percentage of your expenses.
What is a Copay?
A copay is a fixed amount that you will pay for certain routine services upon receipt. Different services will have different copay amounts, as laid out in your health insurance plan. Sometimes your health insurance copays will count toward your deductible, but other times they won’t.
Copays are meant to be affordable, so you may pay $20 for a routine appointment. Some routine checkups or other preventive care may also be offered at no cost but check your healthcare plan for specifics.
Will I Always Have a Copay?
Not all services will have a copay. Every plan is different, and some will only require a copay before you’ve reached your deductible while others still charge a copay for certain services after you’ve reached your deductible.
Most insurance plans will have what is called an out-of-pocket maximum. This amount is higher than your deductible but puts a cap on the total amount you can pay in a year. You will not have to pay any more copays once you reach your out-of-pocket maximum.
Understanding Your Health Insurance Policy
There are many nuances to healthcare benefits that can get quite confusing. Thankfully, Health Planning Associates, LLC. in Macon, Georgia can help you evaluate your health insurance options and weigh the deductible and copays with you to determine the best value. We know insurance, so make us your first call with any healthcare questions.