Difference between Copay, Coinsurance & Deductible


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What is Copay, Coinsurance & Deductible

Understand Copay, Coinsurance & Deductible with an Example

All three cost-sharing options can be summed up in the table provided below:

Suppose a person has a health insurance policy of Rs. 5 Lakh. with a 10% copay on it and Rs. 5000 deductibles.

With the deductible, he further has a 10% coinsurance clause. If the treatment for a certain disease costs Rs. 10,000, his liabilities from these clauses will be:

Copay

Deductible

Co-insurance

10% of the treatment cost. Let’s say the treatment cost amounts up to Rs. 10,000. Thus, during treatment the policyholder will have to bear Rs. 1000 of the treatment expenses and the rest Rs. 9000 will be covered by the insurance policy.

Here, the deductible is Rs. 5000, which the policyholder has to first pay towards his treatment. The policy will start contributing only after the policyholder has paid his/her share of Rs. 5000.

Co-insurance is often levied on policies after the deductible has been paid. If the treatment cost is Rs. 10,000 and the deductible of Rs. 5000 has been paid, the policy will cover the rest Rs. 5000. Out of this Rs. 5000, the policyholder will have to pay 10% of Rs. 5000 i.e. Rs. 500 under the co-insurance clause. The rest Rs. 4500 will be covered by the insurance policy.

What is the Difference between Copay and Deductible?

The difference between copay and deductible clauses can be illustrated in the table below:

Parameter

Copay

Deductible

Applicability

Copay is the fixed portion that policyholders have to pay towards their treatment expenses while the rest is borne by insurance providers. It can be given as a fixed amount or a fixed percentage of the treatment expense.

A deductible is the fixed amount that policyholders have to bear before their insurance policies start contributing and cover the larger portion of your medical bill.

Effect on premium

With larger copay amount, policyholders are liable to pay lesser premiums.

Deductibles also allow policyholders to pay smaller premium amounts.

Coinsurance clause

Copay is often used interchangeably with coinsurance.

Policyholders often have to pay the coinsurance after meeting the deductible part of their policy.

Implementation

The copay clause is levied only on specific healthcare services.

A deductible is implemented before the insurance policy starts contributing to an individual’s treatment expenses.

What is the Difference between Copay and Coinsurance?

Even though these are sometimes used alternatively, copay and coinsurance have certain minute differences. To learn what is coinsurance vs copay, let us take a look at the table below:

Parameter

Copay

Coinsurance

Applicability

It is a pre-determined fixed portion that you have to pay towards the expenses incurred in due course of medical treatment. It can either be given as a fixed amount or a fixed percentage of the treatment expenses.

The actual amount for coinsurance varies. But, the percentage of expenses you need to bear towards your treatment remains fixed as per the coinsurance clause.

Payment process

With the copay clause, you need to make a portion of payments each time you seek any medical service.

Coinsurance needs to be paid for the medical services after you have covered your deductible.

Time of payment

Under the copay clause, you need to bear the expense at the time of seeking service.

The amount you pay towards your treatment is billed by your insurance provider, and you are required to pay directly to them.

Effect on deductibles

Copay count towards deductibles only under certain circumstances.

Coinsurance is paid only after meeting deductibles.

Differences between Coinsurance and Deductible

Now that you have learnt the differences between copay and deductible and that between copay and coinsurance, it will be easy enough to differentiate between coinsurance and deductible. Some of them are as follows:

Parameter

Coinsurance

Deductible

Applicability

It is a fixed percentage of expenses incurred towards treating a disease that policyholders have to bear while the rest is covered by their insurance provider.

Deductible refers to the fixed amount that insurance holders have to pay to cover medical treatment expenses before their insurance policy starts contributing.

Payment limitation

Coinsurance is paid every time you raise a claim against your insurance policy.

The payment towards deductibles for one year ends after you have paid the stipulated amount. You will again be required to pay the deductible next year.

Payment amount variability

The amount paid towards coinsurance varies according to the expenses borne towards treatment.

The amount for deductible remains fixed.

Risk factor

As far as liabilities are considered, coinsurance bears more risk because you will have to bear a particular percentage of the treatment expenses. This can be a substantial amount if the cost for treatment is high.

Deductibles do not pose as a liability because the amount to be paid is fixed, even if the treatment costs are substantial.

So, now that we have learned at length about what is copay, coinsurance and the deductible and their differences, it will be easier to seek out health insurance policies with the maximum benefits.

 

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