Understanding how insurance works can feel like learning a new language. Terms like copays, deductibles, and coinsurance are simply the "rules of the road" for your health plan—they determine how you and your insurance provider share the cost of your care. Knowing these basics can help you plan your budget and focus on what matters most: your well-being.
Breaking Down the Terms
A copay (short for copayment) is a fixed amount you pay for certain services. For example, if your plan includes a $20 copay for a therapy visit, you would pay $20 each time you receive that service. Keep in mind that many insurance plans reset annually — typically on January 1.
A deductible is the amount you must pay out of pocket before your insurance begins covering some costs. For example, if your deductible is $100, you’ll be responsible for the full cost of your healthcare services until you’ve paid that amount. After your deductible is met, you may only be responsible for a copay or coinsurance.
Coinsurance is the percentage of costs you share with your insurance provider after your deductible has been met. For instance, if your coinsurance is 20% and a therapy visit costs $100, your insurance would cover $80, and you would be responsible for the remaining $20.
When you schedule an appointment with us, we submit the visit details to your insurance provider for processing. Afterward, we’ll email you any outstanding balance, which may include copayments or coinsurance. Costs can vary based on your specific coverage and the services you receive.
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