Thought Leadership

Coinsurance vs. copay vs. deductibles and how they are used

Healthcare costs can be challenging to understand.

The out-of-pocket cost (what you pay) is variable and dependent on the type of insurance plan a person has and the terms and conditions within that plan – not to mention additional questions about copays, deductibles, and coinsurance. But what does it mean for you in terms of how you go about paying and finding healthcare services?

What is the difference between copay, coinsurance, and deductibles?

While copays and coinsurance dictate what you pay for care, out-of-pocket maximum and deductibles dictate when and why you pay what you pay. Deductibles are typically the amount you have to pay before your coverage kicks in. 

A copay is an amount you owe for a healthcare visit. It's a flat fee, such as $400 for an emergency room visit or $20 for a specialist visit. Usually this is paired with other items to make up how much you owe out of pocket, like coinsurance which is the percent of costs you pay once you hit your deductible. One key difference between copays and coinsurance in particular is that copays are a fixed amount, while coinsurance is a percentage of the total cost. This means that copays will always be the same, regardless of the cost of the service, while coinsurance will vary based on the cost of the service. 

Understanding the difference between copays and coinsurance can help patients make informed decisions about their health care and choose a health insurance plan that best meets their needs. 

Poppins Health’s cost-sharing helps members get affordable high-quality care

With what you know now, imagine trying to find a physician that fits the following criteria. 

Let’s say you are looking for…

  • A primary care appointment within the next week 
  • Good quality physician at a nearby facility 
  • Low out of pocket costs

Where would you start?

Most people seek doctors through recommendations from friends and family or by going online and searching review sites like Zocdoc and Google, which aren’t always the most objective. Between a deductible, coinsurance, and copays, understanding out-of-pocket costs can be very difficult.

Now imagine there was a way to easily find physicians and understand your options.

Poppins Health does not have deductibles or coinsurance. Instead, Poppins Health’s version of a copay, a “dynamic copay”, is tied to provider quality, cost, and patient experience data. In this way, folks have greater insight into the doctors they are seeing simply by asking for the price.

Transparent pricing is the key to better healthcare savings and decisions – and that means getting rid of the jargon and making it easier for folks to understand how they pay for healthcare and what it is actually going to. 

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