Cigna Copays, Deductibles, and Coinsurance Definitions
The following terms are commonly used in insurance: copays, deductibles, and coinsurance. These terms are used to describe the frequency and amount that patients are obligated to pay for their health or dental care based on their coverage. A description of these terms is outlined below.
Copay
A copayment or copay is a flat fee the individual will pay for a prescription or visit to the doctor. A copay is due at the time of the visit for a patient who is sick and goes to the doctor. The patient may also have a copay for a prescription medication.
The copay amount is typically printed on a patient’s health plan ID card. It indicates the cost the individual is responsible for when obtaining medication, at the time of service, or after a doctor’s visit. An individual’s copay is a predetermined rate and based on the specific insurance plan.
The copay will vary based on the individual’s plan and not all patients may have a copay. A plan may not use a copay to share the cost of covered expenses. In some cases, the plan may use a combination of a copay and a deductible or coinsurance. Other plans work by covering the full cost of specific services. This can include various services which are considered preventive and may include annual checkups or routine checkups at the dentist.
Deductible
A deductible is the amount an individual will pay annually for eligible medical services or medications. Once the deductible is met, the health plan will begin to share in the cost associated with covered services. As an example, an individual with a $3,000 annual deductible will pay the first $3,000 of all applicable medical costs before the plan starts helping pay for services.
Deductibles are different from the monthly premium associated with the plan. Once a deductible is met, the plan will assist with covered medical costs. The individual will still be responsible for paying their monthly premium associated with the plan.
Patients who are generally healthy and do not anticipate expensive medical services may benefit from a plan with a higher deductible and lower premium. If a patient has a serious medical condition or is expecting their family will have costly medical services, it may be better for them to use a plan with a lower deductible and higher premium. These plans pay for a larger portion of the overall medical costs and are generally helpful for patients with health issues or significant medical needs.
Copay and Deductible
The copay and deductible will vary based on the specific plan a patient has. It is possible for a patient to have both a deductible and copays. Individuals with high-deductible plans commonly have health-savings accounts (HSAs) to help offset their medical costs. The IRS requires that the plan’s deductible is satisfied before any coinsurance or copy can be applied.
Coinsurance
The coinsurance associated with a plan is a portion of the medical cost after the deductible is met. Coinsurance works to share eligible costs between the patient and their insurance carrier. A higher coinsurance percentage means the individual is responsible for a larger portion of the overall cost. In addition, the patient is responsible for charges not covered by the plan.
Contact the office today to discuss any questions regarding our services. Our team can also help answer questions regarding your insurance coverage and how it may impact the cost of applicable services.