Copay or Not?

Q. I want a copay plan. I have always had one with my employer but now that I am looking for coverage on my own some agents are trying to talk me in to a plan that does not have copays. Won’t this cost me more when I go to the doctor?

A. The simple answer to your question is yes. It WILL cost more to go to the doctor under a plan that does not have a copay . . . but only IF you look at what you pay for services rendered.

Under most copay plans you will be responsible for anywhere from $10 - $50 for an office visit. Any balance is paid for by the carrier direct to the provider. The cost of this extra provider payment, as well as the administrative fees associated with adjudicating and paying a small claim are added to your premiums.

In your situattion the two plans most similar in benefits had premiums of $327/month and $464/ month. So you are paying $137 EXTRA each month to have a $40 copay.

If you did not have a copay your net cost (after repricing) for the doctor visit would be in the $60 - $70 range.

If you go to the doctor every month for the next 12 months the copay plan will cost you $137 + $40 every month for a total of $2124 per year.

If you do likewise under the no copay plan you will pay $840 per year for the cost of your office visits.

The difference in the two plans is $2124 - $840 = $1284 per year.

Which is a better “deal”?

This entry was posted on September 24, 2006 at 11:49 am and is filed under Uncategorized. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response or trackback from your own site.

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