Overall understanding of co-pay, deductible, coinsurance and out of pocket expenses

  • Copay is a set amount that the patient is required to pay each visit.  Some common copay amounts are $20, $25, and $30.

  • Deductible is an amount that the insurance company requires the patient to pay at the beginning of each year, or the beginning of each policy cycle, before the insurance company will start to pay claims.

  • Coinsurance is a percentage of the allowable amount of the claim that the insurance company requires the patient to pay per visit.  A common coinsurance is 80/20 where the insurance company pays 80% of the allowable amount and the patient is required to pay 20% of the allowable amount of the claim.