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How to Compare Health Insurance Plans Before You Purchase Health Insurance


Updated September 02, 2013

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Money Question #3: What Co-Pay Is Expected for Each Medical Visit?

Your co-pay is the amount you pay for each visit, regardless of whether the visit is covered by insurance. It’s usually something like $25 or $50 per visit. Along with this question is a similar one: When does the co-pay apply? For example, some plans don’t require a co-pay for a well-visit or check-up. Others will, or won’t charge a co-pay for testing appointments.

Now multiply the co-pay as it relates to your set of assumptions in Step 6 (Question #5). A co-pay charged at $25 for each doctor visit and test would be 17 x $25 = $425. A co-pay charged at $30 for visits but not for tests might be $360.

Now find out what the additional co-pay percentage is - also called "co-insurance." Once your deductible has been met, you will still be responsible for that additional co-insurance amount, usually expressed as a ratio like 80/20 or 60/40. That means that the insurance company will pay 80% (or 60%) and you will be responsible for the remaining 20% (or 40%) of the bill. An 80/20 ratio will require you to pay higher monthly premiums than a 60/40 because it will mean your insurance company is responsible for more of your bill, whether or not they ever really need to pay it.

Yes, all this math is a pain, but as best you can, use your assumptions and these numbers to figure out what your health and medical visits and tests will cost you. A few minutes of difficult math may save you thousands!

Of course, you'll need to do this math for each insurance plan that seems like a good possibility for you.

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