Co-pay in Health Insurance – Boon or a Bane

Updated on February 18, 2021

The constant rise in the cost of medical and healthcare treatments has made it almost impossible for most families to avail the right medical attention they need. Even with advanced technology and better options for healthcare facilities, we still lack medical facilities with affordable rates. Which is where health insurance comes into play. Getting the right health insurance policy can not only help provide you with financial aid in emergency situations but also ensure the best of treatments for you and your loved ones. 

Co-pay in Health Insurance

In any general health insurance policies, the insurance providers take care of your medical expenses, when it is time to pay the bill. However, in a co-payment scenario, the policy-holder pays a part of the amount, while the rest will be taken care of by the insurance provider. This part amount is mostly fixed by the insurance provider based on their policy guidelines for different services and drugs, subject to the nature of treatment and medication required. Basically, a co-payment feature allows the policy-holder to contribute a part of the medical expenses incurred, while the insurance provider takes care of the rest. 

Advantages of Co-payment

  1. In a co-pay, generally, the policyholder pays a percentage of the actual expenses incurred in case of hospitalisation. So, when it comes to premiums, they can avail the policy at a lower premium and save money on this periodic expense, even if they have to pay a higher amount during the hospitalisation.
  2. With co-pay in place, the policyholder will not make claims for small ailments like a common cold or fever and be more mindful in terms of making a claim, thereby making the right use of the claim.

Disadvantages of Co-payment

  1. One of the major delights of having a health insurance policy is that it comes in handy in case of an unplanned or emergency medical situation. However, with a co-pay in place, it might be difficult for the policyholder to arrange funds for the medical expenses at the right time, ultimately defeating the purpose of a health insurance policy.
  2. Although co-pay allows you to pay a lesser premium, if the policyholder happens to be someone who is more likely to get hospitalised on a regular basis for recurring treatment, you might end up spending more on the treatments and not save anything from the premiums. 

On a final note, co-pay only works the best for policyholders who are young and in the best of their health. This way they can save from lower premiums. Whereas, senior citizens should not avail for a co-pay for it could be an expensive decision for them and prove to be a burden that inconveniences them in a time of need. 

The Editorial Team at Healthcare Business Today is made up of skilled healthcare writers and experts, led by our managing editor, Daniel Casciato, who has over 25 years of experience in healthcare writing. Since 1998, we have produced compelling and informative content for numerous publications, establishing ourselves as a trusted resource for health and wellness information. We offer readers access to fresh health, medicine, science, and technology developments and the latest in patient news, emphasizing how these developments affect our lives.