Skip to ContentSkip to Footer

A Beginner's Guide to Health Insurance Deductibles and Copays

Family at the doctor's office

Deductibles and copays are both out-of-pocket expenses. Although they both represent a percentage you must pay when seeing a medical practitioner, they are not the same. Your copay is a fee you pay when you fill a prescription or receive medical services. The deductible is an agreed-upon amount you must pay before the total cost of your treatment is covered. Your policy explicitly defines these details, so it is important to review the terms closely.

Understanding the Difference Between Deductibles and Copays

Health insurance plans often have different copays for different services. For example, a routine checkup is the least expensive service, and a hospital visit is usually the costliest. In some cases, a copay may not be required. Some plans offer complete coverage for routine health checks, with no copay for your doctor visit. Your copay cannot be applied to your deductible. Copays are standards for both HMO (Health Maintenance Organization) and PPO (Preferred Provider Organization) plans.

Although deductibles are an out-of-pocket expense, it is a set dollar amount you must pay toward covered medical expenses before your health insurance company starts paying for all or some of your medical services. Some insurance plans may also have multiple deductibles:

  • Family plans: Health insurance plans that cover a family often have two deductibles. One is for the policyholder, and the other is for their immediate family.
  • Prescriptions: If you have a health insurance plan that covers drugs, its deductible might be separate from what you pay toward other medical services.

Not all services require that you meet your deductible before your health insurance covers the cost of your care. The following types of preventive care are fully covered by most plans:

  • Cancer screenings
  • Routine exams
  • Immunizations
  • Periodic preventive health screenings

Generally, the lower the premium, the higher the deductible, so don’t assume that a cheaper health insurance plan is the best choice. Otherwise, you may have to cover a large deductible before your health insurance provider starts to cover the cost of your treatment.

Need Help with Health Insurance?

If you are looking for the best health insurance for you or your family, it can be a stressful and complicated task to navigate without help. To ensure you obtain the best coverage at a rate that matches your budget, it is important to work with an experienced insurance agent to compare plans and costs. Our insurance agents understand how important health insurance is and will work with you to ensure you select a plan that will work best for you or can review your existing health insurance to find a better rate or coverage.

Our local agents live and work in the area and are committed to assisting our friends and neighbors to find the health insurance that makes sense. We are dedicated to client satisfaction and will provide knowledgeable, friendly, and personalized services. Contact one of our local insurance agents today for assistance in finding a plan that works for you.

Get A Quote

* indicates required fields

This field is for validation purposes and should be left unchanged.

Customer Reviews
5/5

Unbiased advice, outstanding product options, and excellent customer service.

BM
Blake M
5/5

I never would have found all of the ins and outs on my own.

Deborah S photo
Deborah S