Deductible vs. Copay | Sapling

Deductible vs. Copay

Will My Kids Get Back Pay for My SSD?
Jul 26, 2011
2 minute read

Deductibles and co-pays are two types of out-of-pocket costs associated with insurance plans. Health, vision and dental insurance may have co-pays -- shorthand for co-payment. Most types of insurance, including auto and homeowner's insurance, may have deductibles, and some plans have both. Your insurance policy outlines what out-of-pocket costs are associated with your coverage.

Deductible

A deductible is the dollar amount of covered services you're responsible for before your insurance plan begins coverage. Most deductibles cover a calendar year, which means each January 1 your deductible starts over. For example, your dental insurance has a $150 annual deductible. You've met your deductible as of June 2010, and your plan begins to cover services. On January 1, 2011, you need to pay the $150 again.

Your deductible may be different for different services under your plan, and if the plan covers your family, there may be a deductible for each member as well as a family deductible. For example, your plan may have a $25 deductible for each member of your household and a $75 deductible for your family.

Co-pays

A co-pay is a set amount that you pay out of pocket to see a health, dental or vision provider. For example, your plan may have a $15 co-pay for you to see a primary care physician and a $30 co-pay for a specialist. Your co-pay may also be based on the services you receive. Your co-pay for an annual physical, for example, may be $0, but other primary care doctor visits may be $15.

Deductible vs. Co-pay

Deductibles are typically a larger dollar amount than a co-pay. Some insurance plans may have a deductible of $500 or more, while co-pays are typically under $50. Your insurance plan will specify whether you need to pay the deductible before your co-pays apply or whether you can pay your co-pay amount for some services, even if your deductible isn't met. Your health insurance plan, for example, may have a $250 deductible but all primary doctor visits have a $10 co-pay, even if your deductible hasn't been met.

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Coinsurance

Your health, dental or vision insurance may also have coinsurance -- a percentage of covered services that you are responsible for paying. For example, your plan may have a 20 percent coinsurance for specialist visits, so if your specialist visit cost $400, you would pay $80. Your insurance plan may have coinsurance, co-pays, a deductible or all three.

Melinda Hill Sineriz

Melinda Hill Sineriz has been writing professionally for over 10 years. She worked as an editorial assistant for Forward Movement Publications in Cincinnati, Ohio. She wrote for several years for allmusic.com and edited and wrote a chapter…

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