Our “What’s in a health word?” series helps decode the language of health insurance.
Deductibles and monthly premiums are not the only financial terms to consider when selecting a health plan. Even after your deductible is met and your monthly bills are paid, you still may be required to pay a share of your medical expenses.
Usually these costs come as coinsurance or a copay.
Paying your share
- Coinsurance is a portion you pay toward any medical expense, regardless of your deductible. Your policy may require that you cover 15 percent of any health bill. So if your doctor bill amounts to $200, even if you’ve met your deductible, you would still be responsible for $30 of that bill. Your insurance company would pay the remaining $170.
If you need a prescription or visit a doctor or hospital, a plan with lower coinsurance is easier on your wallet.
A flat service rate
- A copay is a fixed amount, not a percentage, that you pay each time you need a medical service. Your copay can depend on the type of service you receive: an annual checkup will usually cost less (say $20) than an emergency room visit (say $100). Copays also may apply to prescriptions.
If you visit the doctor frequently or have several ongoing prescriptions, low copays could be a an important factor in your health plan selection.
If you look for a plan with the lowest copays and coinsurance, you might pay more for your monthly premium payment, or the insurance company might keep costs down by limiting which hospitals or doctors you can visit.
There are more examples of insurance jargon than we care to mention, but you can find a big glossary at the Washington Healthplanfinder.