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Health Insurance Co-Payment V/S Health Insurance Deductible

Published On Apr 29, 2021 5:30 AM By KANIKA WADHWA

When it comes to purchasing health insurance, you should be aware of a number of words that can be frustrating. Someone without the proper details, particularly when it comes to terms like copay, deductible, and coinsurance, may quickly become perplexed.

Health insurance policies have copays and deductibles. They both require payment from the insured, but the sum and frequency are different.

Health Insurance Co-Payment V/S Health Insurance Deductible

What Is Health Insurance Co-payment and How Does It Work?

A copay, or copayment, is a set fee paid by a healthcare beneficiary for covered medical services. The remainder is compensated by the individual's insurance company. Within the same package, copays usually differ for different services, particularly when they include services that are considered necessary or routine versus services that are considered less routine or in the domain of a specialist.

Ordinary clinic visits usually have lower copays than specialist visits. It's worth noting that copays for emergency room visits are typically the largest. For eg, if an individual accepts a 10% co-pay and the accepted claim is Rs 1 lakh, he will be required to pay Rs 10,000. The remaining 90% will be covered by the insurance company.

What Are Health Insurance Deductibles and How Do They Work?

Deductibles are a set amount of money that policyholders must pay before their insurance kicks in and pays for their medical treatment. The time that deductibles must be paid is determined by the insurance company, whether it is per year or per treatment. A premium is a set amount that a patient must pay per year before their health insurance coverage kicks in. Beneficiaries usually pay coinsurance—a portion of costs—for all benefits provided by the contract until hitting the deductible. They continue to pay the coinsurance until they have reached their annual out-of-pocket limit.

Health Insurance Co-Payment V/S Health Insurance Deductible

The distinction between a co-payment and a deductible is that the latter occurs only once a year. Once the policyholder has reached his deductible for the year, he is exempt from paying all further deductibles until the next year. A copayment is a continuous procedure. When the policyholder receives health insurance, he continues to pay co-payments.

Also Read: Health Insurance Deductible Explained

Co-Payment and Deductible

Take Away

Copays and deductibles are two components of healthcare coverage. Copayments and deductibles are typically higher in plans with lower monthly premiums. Copayments and deductibles are lower in plans with higher monthly premiums. Consider if you expect to have a lot of medical costs when choosing a package. If this is the case, it could be more cost-effective to purchase a more costly plan with lower copays and a lower deductible. Also, keep an eye on the gross out-of-pocket spending cap.

Disclaimer: This article is issued in the general public interest and meant for general information purposes only. Readers are advised not to rely on the contents of the article as conclusive in nature and should research further or consult an expert in this regard.

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