The table below depicts the differences between copay and deductible in health insurance:
A fixed percentage of the claim amount the policyholder needs to pay.
A fixed amount the policyholder has to pay at the time of making a claim.
Applicable to specified medical services. Can vary as per the medical service availed.
Applicable for all types of health insurance claims, irrespective of the type of medical service.
Impact on Policy Premium
The higher the copay clause, the lower will be your health insurance premiums.
If the policy already mentions deductibles, it might not have a direct impact on your health insurance premium.
Although copay and coinsurance seem similar, there are some stark distinctions between them. The table below depicts the differences between copay and coinsurance in healthcare plans:
A fixed percentage of the claim amount the policyholder needs to pay over and above the deductible.
You must pay the copay amount every time you make a health insurance claim.
You need to make the coinsurance payment only after exhausting the deductible.
The copay amount has to be paid at the time of filing the claim.
You can pay the coinsurance amount after seeking medical care.
Copay and deductible usually do not exist together.
Coinsurance is applicable only after the payment of the deductible.
The table below illustrates the differences between the deductible and coinsurance in healthcare plans:
It is mandatory to pay the deductible every time you make a health insurance claim.
The amount you need to pay remains fixed irrespective of the claim value.
Since it is expressed as a percentage of your claim value after deducting the deductible, the amount you need to pay may vary.
As deductibles are fixed, there aren’t too many drawbacks.
You can incur significant out-of-pocket expenses if your total claim value is on the higher side.