![]() ![]() ![]() Then, after reaching the deductible, the copayments apply again. Once you have used your allotted number of copay visits to your primary care doctor, you must pay for any extravisits out of pocket, up to your deductible amount. In most health plans, for example, the deductible is waived for a certain number of visits to a primary care physician (PCP) - typically, the first three in a year. Fees are determined by the company and may vary, depending on the plan, medical service or prescription drug.Ĭopays can take effect before or after the customer has met their annual deductible. It's another way insurance companies share the cost of medical services. What is a copayment (copay)?Ī copay is a flat fee the customer pays for a health care service. You would have to pay out of pocket for these health care services. Health maintenance organizations (HMOs) and exclusive provider organizations (EPOs) usually do not offer any coverage for out-of-network care. The coinsurance for a primary care doctor in your network might be 20%, while the coinsurance for an out-of-network primary care doctor might be 75%. For preferred provider organization (PPO) members, the coinsurance percentage might depend on whether the professional is in the plan's network or not. The amount of coinsurance also depends on the type of health insurance organization insuring you. So you might pay different amounts for doctor’s visits, lab work, prescription drugs and other needs. ![]() The insurance company may apply different coinsurance percentages for each health service. If you need a $10,000 medical service, you would pay $2,000 and the insurance company would pay the remaining $8,000. Let's say your health insurance plan comes with 20% coinsurance. ![]()
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