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. 

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.  If you’d like a professional team to help you make these decisions, HealthyMarks is just a phone call away.