Doctor's Visit Co-pays -  a Good Deal or Not?
by Emily Harding

One of the effects HMO's have had on us whether we realize it or not has been to change our perception of what a quality health plan is supposed to be. Today, rather than looking at how well a plan will protect us if we are really sick or hurt and need the best possible care that might not be available in our local area, we first look to see how low the co-pays are for doctors visits and prescriptions and whether or not or annual physicals will be "covered" or not by the plan.. Little do we realize that a plan with low co-pays for these kinds of expenses might SEEM wonderful, but we forget to look at the extra premiums we are paying each and every month for a plan that offers these bells and whistles as compared to one that has a $500 deductible. The difference in the premium cost of the two plans might be as much as $150 or $200 a month more for the plan with the $10 co-pays for doctors visits and prescriptions depending on other considerations. However, lets assume that the difference is just $50 a month extra for a$150 a month plan that has co-pays for doctors visits as opposed to having to pay for the doctors visit until the deductible is met with the less expensive $100/mo plan. Which plan is the "better value"?

Lets assume in a typical year you see a doctor three times and maybe have one prescription filled for antibiotics. If you had to pay for the visits yourself at $80 each they'd total $240. The prescription cost lets say would be about $30. If you chose the plan without the co-pays, these $270 of medical expenses you would have incurred in a typical year would count towards your annual $500 deductible. 

In this year you health care costs with the plan without the co-pays would amount to :

$1200 - premiums ($100/mo)
    270 - out of pocket - towards deductible
$1470  - total health care cost

Your health care costs under the plan with the co-pays would have cost you:

$1800 - premiums($150/mo)
      40 - co-pays ($10 each)
$1840 - total health care cost

1840 - 1470 = 370
370+270=640

In actuality,  for the $270 worth of services you received, you paid $640 for with the plan with the co-pays whereas you could have had the plan without the co-pays and paid just what the services actually cost and saved money .

Another thing to keep in mind with co-pays is that co-pays just go out the window. They never go away. In a plan that has no co-pays, eligible expenses count towards your deductible and coinsurance or out of pocket maximum. With these plans, there can often come a time when the insurance company pays 100% of your medical  and prescription expenses after you have reached your out of pocket maximum. A co-pay plan will never cover you 100% because the co-pays never go away.

So, are co-pays such a great deal? You need to look at your own individual situation. How much are you really paying? You now know you are paying a LOT more than just the co-pay.....