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  • Jenn Williams

The Difference Between Copay & Coinsurance

With open enrollment in full force, you probably see certain words, such as copays and coinsurance, pop up. So, what is the difference between a copay and a coinsurance? Both are related to health insurance, but that is where the similarities end.


Follow along as we will explain the distinctions between copay and coinsurance and help you understand how they work. We will also provide tips on reducing expenses related to both - saving money is the definite winner here.

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The Difference Between Copay and Co-insurance


Copay and coinsurance are health insurance payments, but they have different meanings. A copay is a fixed amount you must pay each time you see the doctor or purchase a prescription. That means you may have a $20 copay every time you visit your primary care physician.


In contrast, coinsurance is the percentage you pay after you've met your deductible - regardless of the number of times you visit the doctor for health care services or purchase prescription drugs. For example, if you have 25% coinsurance, you pay 25% of each medical expense, and your health insurance provider will cover the other 75%.


Another way to think about it: Copays are fixed, and coinsurance will flex (depending on your services).


Tips for Managing Copay and Coinsurance Costs


If you want to reduce your expenses related to copay and coinsurance, there are a few things that you can do. First, choose a health insurance plan with a lower deductible, as this will help minimize out-of-pocket costs when you need medical care.


Secondly, research your area's best deals on healthcare services and prescription medications. That can include shopping around to compare prices or taking advantage of discounts and coupons that may be available. When comparing health insurance plans, knowing you're getting the best price for the covered services can take a lot of work.


One method to get fast answers is to use an easy lookup tool, such as the SIP Easy Quote Tool. This tool allows you to compare multiple plans that meet your needs for a price you can afford in less than 2-minutes.





TRN: Helping You Find a Health Plan That Works For You


When shopping for a health insurance plan, pay attention to how the plan descriptions specify the premiums, deductibles, copays, coinsurance, and out-of-pocket limits. Mostly, premiums will be higher for plans that offer more favorable cost-sharing benefits.


A low-cost plan with higher limits may work for you if you're healthy. However, if you expect significant healthcare expenses, spending more on premiums each month so it will cover more costs might be worth it.


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