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CO-PAYS
CO-PAYSThe flat fee you pay for specific areas of the policy, where the deductible does not apply. For example: $30 Physician Visit, $50 Preventative Care, $50 Urgent Care, Medication; $10 Generic, $35 Brand, $55 Non Brand. This is an important part of the process ... co-pays versus deductible.
Remember our segment on deductibles and co-insurance and we talked about how some items are not covered under the co-pay and actually goes against your deductible. The example we used was the doctor co-pay covers only the doctor visit and none of the test, lab work, or x-rays ordered by the doctor. Unless, the co-pay specifically states those items are covered under the co-pay. I can’t stress enough how important it is to understand this part of your policy and to make sure you ask the right questions of your agent and/or insurance company.
Now it is true that some co-pays will include items such as test, lab work, and x-rays just make sure your policy does cover these items, if it is important to you to have them covered. You don’t want to have that surprise when you get your bill and find out that you owe $340 for lab work that wasn’t covered under the co-pay.All PPO's have co-pays ... make sure your broker advises you on what the co-pays are, how they work, and what the best value is, as it pertains to premium, and the balance needed to create maximum value. Not all plans have co-pays. Some plans simply have a co-insurance after the deductible is met. So, once you pay the deductible your co-insurance kicks in and you pay your portion. An example would be a plan that states all doctor visits are 20% co-insurance once the deductible is met, which means once you have paid your deductible doctor visits will be covered based on the co-insurance percentage. Your policy will specifically state whether the deductible is waived with the co-pay and if any items are included in the co-pay or if they will be applied toward your deductible.
Be careful of the agent who simply states you have a $30 co-pay to see the doctor and everything is covered. It may cover test, lab work, and x-rays if performed at the doctor’s office, but it may not. You need to verify it and ask the right questions.The question now is it worth having co-pay’s in your policy for items like a doctor visit? If you have really small children who are always running to the doctor with ear infections, colds, bumps, and all the other things that go with small children . . . the answer is yes. The typical doctor visit is $150, so if you have 2 small kids who average 4 visits a year that’s $1,200 in doctor visits per year not counting any appointments Mom and Dad will have. Your monthly premium will go up by $100 to $200 a month when you add co-pays for doctor visits to your policy, so if you only go to the doctor once or twice a year you are better off paying the doctor visit when you go versus increasing your premium. Again, if we look at the math why increase your annual premiums by $1,200 to $2,400 to cover $300 in doctor visit charges. A good insurance broker should be explaining these items to you and running the math for you.
