The short answer: only if it's worth paying the extra premium.
A copay is a one-time charge for a particular medical service that you pay at the time the medical service is rendered. Copays are most commonly included for doctor visits and prescriptions. Some plans may have copays for emergency room treatment. Usually only HMO plans have copays for lab tests, x-rays, outpatient surgery, and inpatient hospital stays.
A deductible is an amount that is the total of all expenses that you pay per year before the plan starts to pay for any expenses, usually for items other than those that may be covered by a copayment like doctor visits.
Coinsurance is the percentage or amount that you pay after you have paid the deductible amount that year. Coinsurance could be greater than the deductible or it could be zero, depending on which plan you buy. Sometimes there is coinsurance after a copay, i.e., the plan pays a percentage of the cost after the copay and you pay the balance.
Are copays worth it?
For the same total out-of-pocket for deductible and coinsurance, it will cost more per month to have copays for doctor visits and prescriptions compared to a plan where you pay all expenses until they add up to the deductible.
For any particular individual or family, you need to have some idea how much extra a plan with copays costs per month compared to a plan without copays with a similar out-of-pocket maximum.
If it costs $500 to $1,500 more per year in premium to have doctor visit copays and prescription copays, and you see a doctor three times and get a couple of prescriptions filled, is it worth paying the extra premium per month so copays are available to save maybe $300 in expenses?
Many people would say no, but some people feel more comfortable having copays and are prepared to pay the extra to have a plan with copays.
Prescription copays might be worth it if you ended up needing expensive prescriptions every year and had a high deductible and coinsurance out-of-pocket maximum. In contrast, the limited benefit of physician visit copays that cover only the doctor's time may never be worth it unless you end up going once a month or more.
Comparing copay plans
To simplify the list of quotes, you can:
• select one insurance company at a time under 'Company Name' in the vertical column to the left of the quote boxes.
• narrow the list to a specific range of deductibles using 'Deductible Range' in the left hand column.
• select specific plans to compare by checking the box to the left of each plan, then click on 'Compare' under one of the checked boxes. Select only plans that have a fixed $ figure for 'Dr. Copay'. Those that show a % instead of $ usually refer to coverage only after the deductible is met.
By default, the plans are listed in order from the lowest monthly premium to the highest. You can change the ordering by using the links to the right of "Sort By" at the top of the page.
Not all companies agree to send their plan information to any particular quoting service. There may be more insurance companies to see if you go to the main health insurance page, and then select box "B" and use the second quote system which may have additional carriers, depending on the state.
Plan Design
There can be a difference between plans as to what copays cover. In most plans, the physician copay covers only the doctor's time.
That means that in those plans, you would have to pay the entire cost of lab tests and X-rays until you have paid the annual deductible.
However, in some plans, the physician copay may also cover lab tests and x-rays ordered at the time of the visit, either completely or up to a certain dollar limit.
Click on the link named 'View Details' for a particular quote so you can see what the copay covers and how the plan is designed, e.g., whether there is a limit on the number allowed each year, or if specialist copay is different from a primary care copay.
Don't judge a plan's cost-effectiveness by the deductible alone. Add the deductible to the coinsurance maximum, then compare the totals.