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Take charge: The difference between copays and coinsurance

Learn about your health plan options before open enrollment this fall.


Knowing the difference between a copay and coinsurance can help you make a decision about which Asante Health Plan option to choose for you and your family, and to help you know how to budget for medical expenses.

A copay is a set amount you pay whenever you use a particular type of health care service. For example, on some Asante Health Plan options, there is a copay that applies to physician office visits or urgent care visits. The copay doesn’t change no matter how much the provider charges. Generally, copays aren’t subject to the annual deductible, so it doesn’t matter if you’ve paid anything already for the year or not — you’ll just pay the copay amount.

For example, let’s say that you have a diagnostic physician office visit, and the allowed charge is $150*. If the copay amount for that plan option for that service is $10*, then all you would pay would be the $10, and the plan would pay the rest of the charges.

Coinsurance is the percentage of costs of a covered health care service you would pay after you’ve met your annual deductible. Before you’ve met your deductible, you would be responsible for 100% of the charges. But if you’ve already met your annual deductible, then you would pay a percentage of the costs, and the plan would pay the rest. The coinsurance amount can vary based on the plan option and the type of service.

It’s possible that both copays and coinsurance will apply to a claim. If you have an office visit and the physician orders lab work, a copay could apply to the physician office visit, and then coinsurance would apply to the lab work.

You can find more information on the Asante Health Plan options on myHR or Asante.org

If you have any questions, please email the Asante Benefits department or call (541) 789-4551. You can also submit a case in the Ask HR section of myHR.

 *All amounts are for illustration purposes.

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