What Is the Difference Between Co-Insurance & Co-Pay Insurance?

Co-insurance and co-pay insurance affect how much you have to pay each time you see a doctor. Co-pay insurance is often referred to by the receptionist as your co-pay for the office visit.

Co-Insurance

• Co-insurance is figured as a percentage of the billed amount at a doctor's office. Typically, the insurance company pays the larger percentage, and you pay the smaller percentage.

Co-Insurance Example

• A common type of co-insurance is an 80/20 split. In this case the insurance company pays 80 percent of the office visit, and you pay 20 percent of the office visit. If you visit the doctor and the office visit costs $200, your will have to pay the co-insurance of $40, which is 20 percent of the $200.

Co-Pay Insurance

• Co-pay insurance is a fixed amount that you pay out of your pocket when you go to the doctor's office. This amount does not vary regardless of the cost of the office visit.

Co-Pay Insurance Example

• If your co-pay is $25 and your doctor's office visit costs $200, you will have to pay $25 out of your pocket.

Out-of-Pocket Expense

• Co-insurance carries the risk of higher out-of-pocket expense because as the cost of the office visit rises, your percentage to pay also rises. Your out-of-pocket expense does not change as the bill increases with co-pay insurance.