What does insurance with copays mean?

Contracting private health insurance implies an annual or monthly payment for health services that the contracted insurer covers. In this way, it is the insurer who is responsible for all or part of the client’s medical expenses.

Within the payments that are made during the duration of the health contract, there are premiums and copayments.

Health insurance with copays is a variant that involves paying a small amount of money each time a medical service is used, hence the name copay. This amount of money can be paid each time a service is used or it can be added to the premium paid for the policy.

And no copays?

It is another possibility when hiring private insurance. In this case, the amount to be paid to the insurer, monthly or annually, is fixed. The patient will not have to worry about paying money every time he goes to the doctor, but that service is already included in the payments he makes.

Why are there copays?

The main objective of this payment method of some insurers is to create awareness in the population of the responsible use of medical services. The price of copays is not fixed; It depends on the insurer or the medical specialty that is required.

The payment of the copay each time you go to the doctor, helps the patient only go to the doctor when needed, that is, to contain unnecessary use.

In addition, it contributes to the financing of the health system and reduces the social cost of waiting lists.


For those who don’t see a doctor often, this type of insurance contract means pay-for-what-you-use.

Reduces the amount of money paid for the policy premium.


Having to pay each time you go to the doctor can mean that you don’t go as often as you should.

The amount paid is not fixed, so it can increase if the services are used very frequently.


Since private medical insurance offers so many contracting possibilities, it is important to know what you are going to pay, the coverage that you are going to have, and the services that you can use.

To choose the health insurance that best suits what each one is looking for, there are different insurance comparators that show all the characteristics of each insurer.

 It is increasingly common for insurance policies to be subject to copays, and users are considering taking out a policy with these characteristics. For this reason, it is necessary to know these characteristics to know what protection the different policies have. 

What is the copay?

It is the amount of money that you must pay to use a medical service with the intention of lowering the costs of your insurance. This insurance is recommended for those people who do not regularly attend medical consultations. It means a lower premium payment and in the long run, it will be more profitable.

Although a priori the concept of “copayment” may be negative as if it were an added expense, it must be made clear that it is quite the opposite. Hiring a policy with a copay can become a significant saving in the final bill for health services. For this, it is important that you know the conditions that this type of policy presents

As compensation for this additional payment, insurance policies have more attractive economically speaking, since they have a cheaper premium.

Copay Advantages

The copay has advantages both for you and for the company itself, the main advantages are:

  • It is one of the best and most effective ways to raise awareness of the responsible use of medical services.
  • This distribution of costs prevents the general increase in the premium, which represents one of the greatest advantages for the user.
  • Notable decrease in the policy without diminishing the quality of the medical service, if the user seeks quality medical attention at a reduced price and is a person who does not regularly attend consultations, the co-payment is his solution, since the premium will not increase enjoying the same services

Copay Disadvantages

Health is something that can be controlled to a certain extent, but there is no guarantee that we can avoid the irruption of a period where you have to go repeatedly to medical consultations.

If you have contracted a policy with co-payment and visits to consultations occur frequently, you have the risk that the main advantage, savings, is in danger. Continued visits can cause a significant increase in the premium and lose the money saved by hiring a cheaper policy. The main disadvantages are:

  • The insurance premium with copay can increase annually depending on the policy taken by the insurer.
  • Those people who are going through economic problems avoid visiting the doctor, which in the long run can lead to a severe worsening of their health, leading to a serious illness, which will mean a much larger financial outlay that they cannot bear.

For this reason, it is essential that you are absolutely sure of the services that you are going to need and assess whether this saving on the policy caused by the co-payment compensates you. The insurances with the cheapest premiums are also the ones with the highest copays and vice versa. Therefore, it is essential to know what is as important about the portfolio of services that you are going to contract as the cost associated with its use.

By Cary Grant

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