Copays and coinsurances are terms you may have come across when going to the pharmacy. They are both examples of cost sharing, which involves you, as a member, sharing some of the medication cost with your insurance company.
What’s the Difference Between a Copay and Coinsurance?
A copay is a fixed dollar amount set by the insurance company that you are responsible for paying. In most cases you begin to pay copays after your plan’s deductible is met. It is important to keep in mind that deductibles do not always apply to all drug tier levels and some plans do not have drug deductibles.
Coinsurance is a percentage of the drug cost that you are responsible for paying. The full cost of medications fluctuates, which means this amount may differ throughout the year. Like copays, you may also have to satisfy your plan’s deductible before you begin paying your coinsurance on medications. Coinsurances are usually applied to higher tier levels, such as tiers 4 or 5. It is important to refer to your plan’s formulary and Summary of Benefits when estimating what you will be responsible for paying at the pharmacy.
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