Does Your Policy Have a Copay Insurance Clause? Find Out What It Means

copay insurance

Medical expenses are always on the rise. So, people are on the hunt for good insurance policies. After all, no one wants to foot a huge bill. However, high premiums can deter people from buying good policies. This is where you can take advantage of the copay insurance to enjoy better coverage at low rates.

This article explores copay insurance and what you can expect from it.

What is copay insurance?

Copay insurance is a type of healthcare plan with a clause stating that the insured party must pay a part of the bill. The amount you must pay is fixed. For instance, you may need to pay 10% of the total bill. In this case, if your hospital bill is 30,000, you must pay Rs 3,000 from your pocket. Of course, at this point, this may not seem like a huge problem. But remember, treatments for major conditions flow into lakhs. Thus, having to pay 10% can burn a hole in your pocket. Therefore, you should evaluate a policy carefully before buying it.

Why do health insurance companies offer copay insurance?

Copay insurance is not exactly a favourite amongst health insurance seekers. So, people often wonder why companies even offer these. The following are a few reasons why a policy may contain a medical insurance deductible:

  • With copay, people are liable to foot a certain amount of the bill. Companies add a co payment clause to discourage them from making unnecessary claims. Many patients make claims for generic gastric problems or small ailments. This means that companies must bury their heads in a lot of paperwork. The co-payment clause helps them avoid this.
  • Adding copay in medical billing ensures that patients do not go to more expensive hospitals. Polls in India show that boutique hospitals, high-end clinics, and speciality centres often charge 40% more than regular hospitals do. It encourages patients to go to more affordable hospitals offering high-quality treatment.
  • Finally, copay also decreases the risk and overall liability that an insurance company must incur. They save a minimum of 10% of the total hospital bill. This is because the insured party must pay that themselves. 

So, why would a consumer even consider buying copay insurance?

The biggest drawbacks of leading healthcare plans are often the high premiums that come with them. Most consumers understand that these high premiums can translate to a wider coverage when it comes to illnesses. However, not everyone can afford these insurance policies. Does that mean that the average consumer should buy a sub-par insurance policy and keep his/her fingers crossed? Of course not!

Policies come with a co-payment clause to make the insurance premiums more affordable. With the risk and liability to the company reduced, insurance providers do not fret over offering premium services at lower rates. Some healthcare providers charge as high as 20% as the medical insurance deductible.

Of course, for consumers, the flipside is footing a portion of the bill on their own. But, on the other hand, it does provide them with better policies at cheaper rates.

What to consider before buying an insurance policy?

You’re probably wondering whether to buy copay insurance or regular healthcare plans. You must first jot down your priorities. This can help you pick a plan that suits your needs. Consider the following:

  • Are you taking steps to save money?
  • Do you have any other financial investments planned?
  • Does your family suffer from hereditary diseases?
  • Do your lifestyle choices put you at risk for certain diseases? If you are unsure about it then you can consult a doctor on MediBuddy to find out.
  • Are you earning enough to account for sudden medical expenses?

These factors can help you decide what type of insurance to buy. If you have taken steps to set aside funds for emergencies, and do not want to pay high premiums, then copay insurance may be the right fit for you. Conversely, if you cannot account for sudden medical expenses, perhaps regular healthcare plans may benefit you more.

Copay insurance is not a bad thing. These healthcare plans can allow individuals to benefit from better coverage without paying high premiums. The higher your copay amount, the lower your premium will be. Therefore, you should look at your copay amount carefully before committing. Of course, do take into consideration inflation and typical medical expenses before making your final choice.

Healthcare plans are vital. It is better to have copay insurance than no insurance at all. So, get copay insurance. And always safeguard your health with MediBuddy. 


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