The concept of health insurance co-payments can be confusing to many people. The following will help you understand the issue:
Co-pay: A co-payment is a flat fee or portion of a medical bill that becomes the financial responsibility of a patient when seeking medical services. For example, a patient may have to pay $25 for each visit to a general practitioner.
Co-insurance: Co-insurance and co-pay are often used interchangeably by health care consumers, but they aren’t exactly the same thing. To be precise, co-insurance is the percentage of a medical bill that is the responsibility of a patient after meeting an annual deductible.
Maximum Out-of-Pocket: The maximum out-of-pocket expense is the annual maximum amount the policyholder is required to pay before the health insurance policy provides 100% coverage during a calendar year. Co-payments may or may not count toward the out-of-pocket limit.
There are a few essential questions to consider when speaking with your agent:
1. What is the co-pay in network versus out of network for office visits, out-patient providers and hospitalization?
2. Which co-pay situation applies when my physician visits me in the hospital?
3. Are medications included or excluded? Is there a separate limit or deductible?
4. Can the co-pays be used to satisfy one another