Copay health plan: How it works

Copay plans are said to help you best predict your yearly health care spending. But what does it look like in action?

First, let's talk about what a copay is. It's usually a set fee you pay when you visit the doctor or pharmacy. A copay plan focuses on predictable costs, like $25 for each time you visit a primary care provider or clinic.

Beyond the set fee, copay plans follow three phases similar to other health plans, to help share in the health care cost. First is the deductible phase, when you pay the full cost of care. Next is the coinsurance phase, when you pay a portion and insurance pays a portion. The last phase is when you hit your out-of-pocket maximum—when insurance pays the full cost for the remainder of the year.

Each copay contributes to your out-of-pocket maximum but not the deductible.

To better understand how this plan helps pay for your health care expenses, you can watch this video. You'll learn how the plan works and when insurance kicks in and starts paying (hint, it's typically right from the start with a copay plan). See if this type of health plan might be right for you. 

Note: Grandfathered health plans offered by some employers cover preventive care differently than these illustrations. See your benefit plan documents for coverage details