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Copays and Coinsurance in Health Plans

What's the Difference Between Copays and Coinsurance?

Affordable Care Act (ACA) health plans don't pay for everything. For example, many know there's a deductible to pay before insurance starts helping with covered expenses. The deductible is the responsibility of the covered person. But the difference between a copay and coinsurance is sometimes less clear:

A copay is an amount you pay to receive certain services, for example, $35 for a doctor visit. Not all plans offer a copay and those that do may offer the copay at different times. Some plans may have you pay a copay for some services, but not have it count toward your deductible. Other plans may have you meet your deductible first, then offer a copay for select services.  

Coinsurance is the share you pay of  covered medical expenses after you've met your deductible. So if your coinsurance is 30%, after you meet your deductible, you would pay $30 of every $100 of any covered expenses. The insurance plan pays the remainder, so in this example 70% or $70 of every $100 of any covered expense.

Be sure you understand what your cost responsibilities are going to be before you buy any health insurance plan. Decide on the right mix of deductibles, copays and coinsurance that works best for you.

Questions About Copays and Coinsurance?

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