Copay: What is it, what are its main advantages and disadvantages?


The copay is an instrument implemented by insurance companies, which allows us to pay less for the value of our policy. The cost of the medical service we use is shared with him. Therefore, it becomes a fixed charge that we pay when we go to the doctor or buy a prescription drug. This is usually not such a high amount, since the rest is paid by the insurance company. This is how we ensure adequate care in those moments of urgency.

What is the copay?

Copayment is a mechanism in which the insurance company shares the cost of medical services with the client. In other words, it is the fee or amount of money that the insured must pay each time he requests and receives medical care or service. Basically, every time we visit a care center we must make a payment in order to receive the service. This is previously stipulated in the contract with the insurer, reducing the cost of health insurance.

The amount to pay for the copay may depend on two factors, the type of medical assistance required, or the type of insurance contracted. However, it is not a common regulation among health companies, so not all corporations or plans use this tool to share medical expenses. In some cases, companies can also apply other systems such as a deductible to pay for most medical services one year in advance.

How is it applied in health insurance?

The way the copay works is actually very simple. The insured requests and receives the medical service whenever it is necessary, and each time he does so he must pay a small amount to the institution. This amount will be a percentage of the contribution base income on the value of the service. Obviously, this value must not exceed the amounts of insured coverage in order to be served. In addition, the copayment must be paid by the beneficiary and not by the contributor.

On the other hand, the value of this copayment fee will depend on the income on which we contribute to social security. Consequently, a percentage is set that ranges from 11.50% when we have less than two minimum wages and 17.30% between 2 and 5 minimum wages. While, if you receive an income greater than 5 minimum wages, the percentage will be 23%. In any case, the law establishes a maximum percentage to be paid depending on the salary received.

What are the advantages of co-pay health insurance?

Really, health insurance with copayment offers many advantages that we must value.

  • First of all, this tool helps us reduce many medical costs in private clinics.
  • It allows us access to specialist doctors without increasing the cost of premiums.
  • It is only canceled by the actual use of the service. That is, it can be contracted based on the estimate of our use of medical services.
  •  The copayment contributes to a more conscientious use of health services.
  •  In addition, the copayment allows us to reduce the amount of the insurance premium since we would be sharing part of the expenses with the insurer.
  • It gives us access to quality medical service with specialists without this affecting the cost of the policy.
  • It allows us to influence the cost of the policy and the premiums that we are going to pay, the higher the copayment, the lower the cost of the premium, and vice versa.
  • Medical insurance with copay provides for the reimbursement of some medical expenses such as pharmaceuticals.

What are its disadvantages?

Although there are many advantages to copays, there are also disadvantages. The first one is that, if for some reason we are forced to visit a medical center with some frequency, we will end up spending more money. This is because the copay allows us to save money when they are very sporadic visits, not when they are frequent. Otherwise, the premium can increase its price due to all the expenses that she has to face in each service.

On the other hand, the policy premium may increase annually depending on the policies of each company. Therefore, we will never have a guarantee that we will pay the same amount the following year. Another disadvantage for health is that many people seldom go to the doctor even though they have some ailment. They do this in order to take advantage of the copay benefits. However, this turns out to be worse in the long run, as more specific services will be needed that will cost double or triple.

What does no copay mean?

Normally, when we look for health insurance we find insurers that offer us policies with or without a copay. If we choose the last option we will not have to pay anything every time we need medical attention. This implies that we must pay most of the policy when signing the contract. However, when taking out the policy without a copay, it is very likely that we will have to pay an additional fixed monthly or quarterly fee. This is something that we must read well in the contract specifications.

This is the big difference between these policies and that is why copay insurance is so cheap. However, not all profiles are adapted to this product, since it is necessary to have a reserve of money to pay for medical services. This amount is usually around 100 euros and we will have to pay it every time we receive any assistance of this type. This is why we must do many calculations before making a final decision since both options have advantages and disadvantages.

Medical insurance with a copay or without copay?

Once we have seen this information, a question arises: Medical insurance with a copay or without a copay? For this, we need to have good advice from our insurance broker to make the best decision. In this sense, we can say that copay insurance is ideal for those who want to save money and are in good health. In this way, you pay less for the policy and only spend a few euros each time you go to the doctor.

On the other hand, if our state of health requires frequent visits, that is where the insurance without copay is most beneficial. Although it may be more expensive, it is perfect for those who need constant attention for certain health situations. Well, for a fixed amount we will have all the medical benefits without any additional expense. The copay can be a problem or a great advantage. However, the best of each option must be assessed in order to acquire the policy that best suits us.

By aamritri

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