Co-Pay is the portion of the medical bill that you the policy holder is responsible for when medical services are rendered by a physician, these co-pays are pre-set dollar amounts.

Insurance companies offer unlimited, limited and no co-pay doctor office visit depending on the type of plan that you are purchasing. Typically a plan with limited or a pre-set number of office visits are lower priced when compared to plans that offer unlimited office visits. There are plans that do not require you to meet your deductible before using the co-pay benefit at the doctor.

When to purchase unlimited vs. limited or no co-pay plans? A healthy individual that visits a physician twice a year or less would save money by purchasing a plan that offers no co-pays or limited co-pay office visits, a family with children would benefit by purchasing a plan with unlimited doctor office visits, children are more prone to getting sick, injured and will visit doctors more often during the year. Adults with children will also be more prone to becoming sick so a plan with unlimited doctor office visits would be beneficial in the long run.

Why get hung up on Copay’s only?

Many clients buy health insurance and rate insurance carriers by the doctor office copay amount offered rather than by what type of coverage the plan offers, what is the maximum amount covered, what coverage area the plan offers, what is excluded in the plan, what rating the carrier has and how much risk are you willing to accept.

The option to offer doctor office visit copay’s is not a benefit that is free of charge to you, the policy will have a monthly added cost to cover such benefits and the carrier knows that a healthy individual might visit a doctor one or two times a year, this option usually doesn’t benefit the policy holder.

Health insurance should be purchased based on the following:

1) Type of plan being offered (PPO / HMO / POS)

2) What is covered by the plan, what is not covered by the plan.

3) What is your maximum out of pocket expense with the plan.

4) How much money are you willing to risk if you become ill.

5) Are you covered outside of their network, do you need referrals for specialists.

6) What capacity does the carrier have to pay claims (A.M. Best Rating).

7) What premium can you afford on a monthly basis without having to lapse the policy.

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COBRA: accept or find an alternative?

COBRA stands for “Consolidated Omnibus Budget Reconciliation Act of 1985” which allows the extension of “Group” health coverage to terminated employees and their families for up to 18 to 36 months.

This law does not require the employer to pay the cost of the continued group coverage; the terminated employee can be required and in most cases are required to pay the premium, which may be up to 102% of the premium that would otherwise be charged.

The recommendation would generally be to accept COBRA benefits if you have any pre-existing medical condition that would otherwise preclude you from being accepted by an individual type plan but if you are healthy and with no pre-existing medical condition, you would save money on your premiums and have similar if not better coverage than the plan offered by your employer.

One excellent option is to consider what is known as “Short Term” medical insurance, this type of plan offers major medical insurance benefits for a defined amount of time, usually 6 – 12 months and is less expensive than your standard major medical plans.

HMO stands for Health Maintenance Organization; it is a group of health care providers that have contracted with an insurance company to provide services to its “subscribers’ (Policy Holder) at fixed pre-set prices. HMO’s require its subscribers to elect a primary care physician within their network, HMO’s require a referral from the primary care physician and pre-authorization from the carrier before you can visit any specialist; HMO’s will not cover any out of network physician or hospital visit and are more restrictive on your ability to decide what treatment you may receive. Typically HMO’s are somewhat lower priced plans when compared to PPO’s, physicians are required to see more patients on a daily basis, this will limit the amount of time and services a physician can render to its clients.

PPO stands for Preferred Provider Organization; it’s a large network of Doctors and Hospitals that have contractual agreements with insurance companies; PPO’s are much less restrictive than HMO plans and allow you more control over your medical treatment and who will provide that treatment; you will not need any referral or pre-authorization to visit a specialist of your choice. PPO plans allow its policy holders to visit any in-network or any out of network physician and hospital, however when you visit an in-network physician, you will receive a reduced rate for the services rendered. PPO’s offer a wide array of deductibles, coinsurances and co-pays to help its policy holders customize a plan to suit there coverage and budget requirements.

I have helped thousands of clients over the years with their health insurance needs and I would only recommend a PPO plan.

Co-Pay is the portion of the medical bill that you the policy holder are responsible for when medical services are rendered by a physician, these co-pays are fixed amounts.  Insurance companies offer both unlimited and limited physician office visits depending on the type of plan that you are purchasing. Typically a plan with limited or fixed co-pay office visits are lower priced when compared to plans that offer unlimited office visits.

When to purchase unlimited vs limited or no co-pay plans? A healthy individual that visits a physician less than two times a year would save money by purchasing a plan that offers no co-pays or limited co-pay office visits, a family with children would benefit by purchasing a plan with unlimited doctor office visits, children are more prone to getting sick, injured and will visit doctors more often during the year.