Do You Want or Need an Office Copay in Your Health Plan?

We teach our children at a young age the difference between wants and needs, and in spite of our best efforts their understanding of this concept takes a while to sink in. If you’re a parent like me, you know its just how it is – if your aren’t a parent, go ask one.

And even when we grow up, not all of us have attained a real understanding of the difference. Its confusing and there are many blurry lines.

When it comes to health care, there should be NO confusion – getting care is a need not a want.

But having a copay is a want if you are buying health insurance for yourself.

Sure its convenient, its easy, and its nice to have. But it is not a need and its far more expensive than it is worth if you are buying insurance for yourself. (If you are getting your health insurance from your employer, this post isn’t really for you – get all the benefits you can…)

But when you have to pay for your own insurance, you will pay much more in additional premiums than the copay is worth.

An in-network office visit is going to cost about $45 – $75 after the insurance company discount and depending on whether the care is for primary or specialty care. So a $35 copay is only giving you a $10 to $40 benefit for every visit you have.

The additional health insurance premium you will pay is typically at least 25% more than the same plan without a copay.

So a plan that costs $4000 with a copay would cost about $3000 without an office copay benefit.

That’s a savings of $1000 a year which would cover the actual benefit you would receive on roughly 50 office visits a year.

How many times do you go to the doctor a year and do the math. I am pretty confident you will find out that the office visit is not the right decision.