Deductible and copay—you probably know these insurance terms impact cost. But insurance terms aren’t easy to understand, and when you layer one on top of the other, it gets even more complex. How do the two terms work together? And does copay go towards deductible?
Let’s start by defining the terms.
A copay is what you (the patient) pay in addition to what your insurance company pays. Think of this like ordering food at a fast casual restaurant, you pay before you’re served the meal you order. Later, if you add a drink, that’s more than what you paid upfront.
A deductible is a specified amount of money that you (the patient) must pay before an insurance company will pay a claim. Think of this in terms of car insurance, if you’re in a fender bender, you have to pay your deductible before the company’s benefits will kick in for the rest.
But how do copays and deductibles work together? Do copays apply to deductible costs? In most cases, the answer is no—copays do not count toward the deductible; the copay needs to be paid before the deductible begins.
What does this mean for you?
When choosing a plan, think about how much you use your insurance and how much protection you want against unpredictable expenses. Then look at the plan’s deductible, copays and coinsurance and find what works best for you.
Here are a few things to consider.
- A plan with a high deductible will usually have cheaper monthly payments. But you’ll pay a lot upfront when you need care. You can also look for plans that cover some services before you pay your deductible.
- Typically, the lower a plan’s monthly payments, the more you’ll pay in coinsurance.
- Dental insurance is focused on prevention, so copays on preventive benefits are rare. Some plans may have copays for other covered dental procedures, so be sure to read the benefits booklet for the plan(s) you’re considering and ask your HR administrator or insurance broker for clarification if you have questions.
