How often do people think of making room for their insurance in their overall budget for themselves and their families? Surprisingly, most people forget to add it to their household budgets, because for most people, a co-pay for a doctor’s visit just doesn’t come up all that often. So most people don’t even think to include it in their budgets at all. For all I’ve seen over my many years of being a medical coder, I highly recommend people start looking at adding the insurance co-pay into their family budgets, if for no other reason as calling it the “don’t get burned by co-pays” column.
If you have an elderly family member who is thinking of switching insurance coverage, please look at what it would truly cost your senior citizen members of your family if it’s a high amount, because many older family members go far more often to the doctor than most people. And if they live on a fixed income, not looking at how the insurance co-pay fits into their budget can completely implode that fixed income budget with sad repercussions for your family members….case in point below:
I’ve seen too many heartbreaking stories in my almost 20 year career in the medical field, with most of years as a medical coder when a well meaning family member convinces them to go with a higher co-pay amount.
I looked at the older parent and middle aged son seated across from me, he was sure his high copay amount would convince his mom to switch to another insurance. She of course wanted nothing to do with the plan. The copay amount in question? $90.00
So I asked them to do an experiment I came up with years ago while working with many elderly patients over the years in doctor’s offices
“Ok, so $90.00 is an acceptable co-pay for your mom?”
“Yes!” He replied confidently
“So you think it’s a one time and done type of thing?”
“Well, isn’t it? ” Her son wasn’t quite so sure now….
“I wish I could say in a perfect world, yes, one time would be enough. However, we just don’t live in a perfect world. A perfect world only exists in peoples minds, it’s not realistic sadly enough.”
“Ok, humor me for a minute….your mom has to have a procedure for 5 days straight. How many times will she have to pay the copay?”
“Once?” The son asked hopefully.
I shook my head. “It’s a $90.00 co-pay every day she goes for the procedure, so that’s five days at $90.00 a day copay, how much will that cost your mom in that 5 day period?”
The son went deathly pale and he started to sweat. “$450.00” he whispered.
“Exactly, so how will you mom eat or pay the rest of her bills on a fixed income?”
“I see what you mean of having your copay fit the budget, and on mom’s fixed income, the $450.00 for a 5 day procedure or cancer treatment, it’ll obliterate her budget if I insist on the $90.00 for everything covered, but at what expense will that mean to my mom’s care, to my mom?”
” I don’t know.” I answered him honestly “Something to think about, isn’t it?”
He nodded. Two very sobered people walked out of my small home office that day, however, they returned a couple weeks later for me to help them figure out what would be best for his mom’s budget and still get the kind of care he thought his mom deserved.
Out of pocket maximum is the set amount of money you will have to pay in a year on covered medical costs. In most plans, there is no copayment for covered medical services after you have met your out of pocket maximum. All plans are different though, so make sure to pay close attention to plan details when buying a plan.
A deductible is the amount you pay for healthcare before your plan benefits take effect. … Your plan may have an office visit copay and a separate, urgent care copay, and sometimes a separate emergency room co-pay among others. Coinsurance is the percentage of covered healthcare costs you pay after your deductible has been met. Co-insurance IS NOT the same thing as a co-pay. many people get those two terms mixed up all the time and then I have to explain the difference between the two.
A co-payment, or co-pay, is the flat amount you pay at the time of a medical service or to receive a medication. Each health insurance plan establishes these fees up front — they are often printed on your health insurance card. Insurance companies use these co-pays in part to share expenses with you. In addition to cutting a small portion of the costs, the co-pay is also used to prevent people from seeking care for every trivial medical condition they might encounter. In this way, co-pays can save an insurance company a substantial amount of money. However, while the co-pay has been found to lower costs by making people think twice before running to the doctor over a case of the sniffles, they might also prevent people from seeking necessary medical attention. For example, a person with a chronic condition may need to see four doctors over the course of a month, all of which require a $25 co-pay. However, if that patient cannot afford $100 each month, he or she will most likely skip one, if not all, of those appointments. Co-pays can often total hundreds of dollars each month if you have several health ailments. In these cases, many patients begin to pick and choose which medications they deem necessary, making for a potentially dangerous situation. But most would say that the alternative — no health insurance — would be worse.
Is copay included in deductible? In most cases, copays do not count toward the deductible. When you have low to medium healthcare expenses, you’ll want to consider this because you could spend thousands of dollars on doctor visits and prescriptions and not be any closer to meeting your deductible.
Some common questions I get when it comes to co-pays……
Do you still pay a copay if you have 2 insurances? Honestly speaking from my point of view as a medical coder in the back office? It depends on what insurance you have. Not all insurances think of co-pays between insurances in the same way. The other plan can pick up the tab for anything not covered, but it won’t pay anything toward the primary plan’s deductible. If both plans have deductibles, you‘ll have to pay both before coverage kicks in. You don’t get to choose which health plan is primary, meaning the one that pays first. Does secondary insurance pay for copays? Yes, you can use secondary insurance to pay your deductibles. Plans that offer cash benefits can be used to pay for out-of-pocket costs such as deductibles and copays. So that’s cop-pays in a nut shell….your call to action tis time is to go check and see if your co-pay is compatible with your present budget. No sense getting burned if it can be avoided. and keep checking on how co-pays will affect your budget anytime open enrollment comes around.
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