Deductible and copay—you probably know these insurance terms impact what you pay at your dental office. But insurance terms aren’t easy to understand, and when you layer one on top of the other, it gets even more complex. How do the two terms work together? And does copay go towards deductible?
Let’s start by defining the terms.
A copay is what you (the beneficiary) pay in addition to what your insurance provider pays. Think of this like ordering food at a fast-casual restaurant, you pay before you’re served the meal you order. Later, if you add a drink, that’s more than what you paid up front.
A deductible is a specified amount of money that you (the insured) must pay before an insurance company will pay a claim. Think of this in terms of car insurance, if you’re in a fender bender, you have to pay your deductible before the company’s benefits will kick in for the rest.
But how do copays and deductibles work together? Do copays apply to deductible costs? In most cases, the answer is no—copays do not count toward the deductible; the copay needs to be paid before the deductible begins.
What does this mean for you?
When choosing a plan, think about how much you use your insurance and how much protection you want against unpredictable expenses. Then look at the plan’s deductible, copays and coinsurance and find what works best for you. Here are a few things to consider.
- A plan with a high deductible will have cheaper monthly payments. But you’ll pay a lot upfront when you need care. You can also look for plans that cover some services before you pay your deductible.
- Typically, the lower a plan’s monthly payments, the more you’ll pay in coinsurance.
- Dental insurance is focused on prevention, so copays are rare. If you’re considering a plan with a copay, consider how often you’ll be in to see the dentist.
View more information on how your dental insurance works.