To put it plainly, a copay is the amount you and your insurance agree you will pay for care. Your copayments are a fixed dollar amount that do not change for an entire benefit year.
Copay is not a discount or a coupon because the amount you pay is always static to the dental care event. Copay is essentially a special rate that your insurance has negotiated for you.
Copay varies from plan to plan, carrier to carrier, but it does not vary within a network. If you have a $20 copay for a checkup, you will pay $20 for that checkup so long as you’re seeing your chosen dentist.
Copay is additive, meaning you pay everything that ends up on your itemized dentist bill. Be sure you talk with your dentist and check your summary of benefits before agreeing to procedures to make sure you know exactly what you'll be charged for.
For example, even though a teeth cleaning has a $0 copay, any dental office visit has a $5 copay, meaning that visit will cost you at least $5. The same goes for a crown, even though the copay might be $125, you still will owe the $5 per office visit.
There also might be added material costs or restrictions/special rates depending on the service you're looking to get. That is why it is extremely important you discuss procedures with your dentist before getting them.
What’s the difference between Coinsurance and Copay?
Coinsurance is a percentage-based rate. You pay a portion of your hospital bill based on the cost of the procedure. A 85% coinsurance means you’ll pay 15% of whatever the costs of the procedure are. Meaning, if you get a service that costs $1,000, you will only pay $150 and your insurance will cover the rest.
The MetLife HMO only offers a copay exclusive model. The MetLife PPO plan exclusively uses coinsurance.
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