{"id":191,"date":"2015-08-20T08:00:10","date_gmt":"2015-08-20T12:00:10","guid":{"rendered":"https:\/\/singlecare.com\/blog\/?p=191"},"modified":"2021-11-15T13:05:53","modified_gmt":"2021-11-15T18:05:53","slug":"difference-between-copay-and-deductible","status":"publish","type":"post","link":"https:\/\/www.singlecare.com\/blog\/difference-between-copay-and-deductible\/","title":{"rendered":"What\u2019s the difference between a copay vs. deductible?"},"content":{"rendered":"

Sometimes healthcare terms can seem like a whole different language. With words like <\/span><\/i>copay<\/span>, <\/span><\/i>deductible<\/span>, and <\/span><\/i>out-of-pocket maximum<\/span> being thrown around, how are you supposed to know what\u2019s what? That\u2019s where our Healthcare Defined series comes in. We break down terms so you can understand\u2014and with understanding, comes better savings.<\/span><\/i><\/p>\n

Choosing a healthcare plan? In addition to the monthly cost, or premium, it\u2019s critical to understand what else you\u2019ll be responsible for financially. A copay and a deductible help determine how much you\u2019ll pay out of pocket; these costs can have a major impact on how financially feasible a particular plan is for your budget. Don\u2019t know the difference between a copay vs deductible just yet? We\u2019ve got you covered.\u00a0<\/span><\/p>\n

What is a copay?\u00a0<\/b><\/h2>\n

Copays and deductibles are both types of cost-sharing\u2014you\u2019ll pay for a portion of your total healthcare costs, and your insurance company will typically cover the gap between what\u2019s been billed and what you\u2019ve paid.\u00a0<\/span><\/p>\n

A <\/span>copay<\/span><\/a> is your portion of the fee for a specific instance of care, whether it\u2019s a doctor\u2019s visit or a prescription. It\u2019s usually a manageable amount and may even be spelled out on the back of your insurance card, such as $20 for a doctor\u2019s visit or $10 for a prescription refill. Typically, the higher the monthly premium, or amount you pay for your plan, the lower the copay. For preventive care, such as a mammogram or a yearly physical, you may not have a copay at all. Copays will usually differ for primary care vs. specialty care in your insurance plan\u2019s network, and for brand name vs. generic drugs.\u00a0<\/span><\/p>\n

What is a deductible?\u00a0<\/b><\/h2>\n

Deductibles<\/span><\/a>, on the other hand, are what you\u2019re responsible for paying out of pocket before your insurance company\u2019s coverage begins.\u00a0<\/span><\/p>\n

Once your annual deductible is met, your insurance company <\/span>should<\/span><\/i> begin covering most of your covered expenses, but <\/span>sneaky costs<\/span><\/a> related to coinsurance or <\/span>coverage gaps<\/span><\/a> may still pop up (more on that later). <\/span>
\n<\/span>
\n<\/span>Like copays, the higher your monthly premiums, the lower your deductible usually is, as you\u2019re paying more money to your insurance company upfront. When choosing a healthcare plan, it\u2019s important to note how much you\u2019ll be expected to shell out\u2014in addition to your monthly costs\u2014before your insurance will pick up the rest of the tab.\u00a0<\/span><\/p>\n

\u201cA lot of people have no idea what their deductibles are until they have an emergency,\u201d says Rachel Trippett, MD, a family physician with the U.S. Public Health Service Indian Hospital in New Mexico. \u201cThat\u2019s not the time you want to find out that you have a deductible you can\u2019t afford.\u201d<\/span><\/p>\n

RELATED: <\/b>5 health services to do after you\u2019ve met your deductible<\/b><\/a><\/p>\n

How do copays and deductibles work together?\u00a0<\/b><\/h2>\n

Sounds simple in theory, but how does this work in real life? Let\u2019s break it down.\u00a0<\/span><\/p>\n

Each month, you pay a monthly premium; this is the fee simply to have health insurance. If you receive your health insurance through your employer, a portion of your premium may come out of your paycheck.<\/span><\/p>\n

Now let\u2019s say during the year, you end up breaking your ankle. You have an emergency room visit, along with a few trips to different types of doctors, to get back on your feet.\u00a0<\/span><\/p>\n

This is where your deductible becomes important. You\u2019ll be required to hit your annual deductible\u2014the amount you\u2019ve paid out of pocket for any medical services that <\/span>aren\u2019t<\/span><\/i> copays\u2014before your insurance provider begins paying a higher percentage of your medical bills.\u00a0<\/span><\/p>\n

What is coinsurance?<\/b><\/h2>\n

But on most insurance plans, reaching your deductible doesn\u2019t necessarily mean you\u2019re in the clear for not having to pay anything. Instead, you may also have <\/span>coinsurance<\/span><\/a> fees. This is a percentage of your healthcare costs that you are required to contribute, until you reach your insurer\u2019s annual out-of-pocket maximum. That\u2019s the <\/span>total<\/span><\/i> amount you\u2019ve paid throughout the year for all your medical costs, including copayments (but not including your monthly premium). <\/span>
\n<\/span>
\n<\/span>It\u2019s only once you reach that maximum that your insurer is required to pay for 100% of your covered medical costs. Keep an eye on the calendar, too; policies are usually year-long, so your deductible responsibilities will reset on your annual insurance anniversary or on Jan. 1 if your deductible resets each calendar year.<\/span><\/p>\n

In a nutshell, a deductible is the out-of-pocket amount you\u2019re required to pay before your insurance starts paying anything for your health costs. Copays are separate, fixed fees that usually don\u2019t count toward your deductible that you may be required to pay when you see a doctor or get a prescription filled. Once you\u2019ve met your deductible, you\u2019ll be paying less for your care, but may still be responsible for coinsurance, until you\u2019ve reached your annual out-of-pocket maximum for the year.\u00a0<\/span><\/p>\n

Coinsurance vs. copay vs. deductible: How to avoid extra fees<\/b><\/h2>\n

One of the best ways to avoid unexpected insurance fees is by sticking to doctors and hospitals within your plan\u2019s network. Your insurance has negotiated a lower price for these providers, which usually translates to lower bills and out-of-pocket expenses for you.\u00a0<\/span><\/p>\n

Another is by using a <\/span>SingleCare prescription discount card<\/span><\/a> for your prescriptions. Simply search for your medications and see how much you can save. It can really help if you have a plan without a prescription copay, but sometimes our price can even beat the copay price!<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"

Sometimes healthcare terms can seem like a whole different language. With words like copay, deductible, and out-of-pocket maximum being thrown around, how are you supposed to know what\u2019s what? That\u2019s where our Healthcare Defined series comes in. We break down terms so you can understand\u2014and with understanding, comes better savings. Choosing a healthcare plan? In […]<\/p>\n","protected":false},"author":15,"featured_media":8905,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[2],"tags":[608],"coauthors":[8856],"class_list":["post-191","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-company","tag-health-insurance","franchise-healthcare-defined","wpautop"],"acf":[],"yoast_head":"\nCopay vs. deductible: What\u2019s the difference?<\/title>\n<meta name=\"description\" content=\"This guide will help you quickly understand the difference between a copay vs. deductible and how you can avoid extra healthcare costs.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.singlecare.com\/blog\/difference-between-copay-and-deductible\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" 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