Copays or Coinsurance

Copays, also known as coinsurance is a popular form of cost sharing associated with insurance plans. Not to be confused with deductibles, which are due prior to benefits being paid. You will find this method of cost sharing in Original Medicare Benefits, Medicare Supplement Plans, Medicare Advantage Plans and Prescription Drug Plans.

Flat Dollar Copays and Percentage Copays

The amount of the coinsurance is usually expressed as a flat dollar amount or percentage.

Flat Dollar Coinsurance Example

The very popular Medicare Supplement or Medigap Plan N has a $20 copay for visits to a doctor’s office. This means, regardless of the billing amount, you would only be liable for $20.

Percentage Coinsurance Example

A percentage copay works by you participating on a percentage basis. If you have a 20% copay and your bill is $100, your insurance would pay $80 and you would pay the remaining 20% or $20.

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