There are two separate buckets. One bucket is a hospitalization and out-patient bucket. The second bucket is a copay bucket. They are completely separate buckets. Let's look at the first bucket - the deductible and coinsurance bucket:



For example: If you need to have your appendix removed, you will go to the hospital. Perhaps it will cost $30,000 for the operation. What do you pay? You will pay your deductible and your coinsurance. The balance of what is due will be paid by the insurance company.

Coinsurance? What is that? You have never heard of that! You and Blue Cross co-insure the first $10,000 of the $30,000 operation. If you have a 70/30 plan, you will pay 30% of the first $10,000 or $3,000 and Blue Cross will pay $7,000. After you have paid your deductible, of let's say $2,500 and your $3000 coinsurance, you do not owe any more. It doesn't matter if it was a $1,200,000 operation, you don't have to pay any more than the $5,500, ($2,500 + $3000). Since you have reached your deductible and coinsurance, you don't pay anything more for the rest of the year. You may have copays as you visit a doctor.

Now, let's look at the copay bucket:

You wake up Monday morning and you have a head cold that is killing you. You know that if you don't see a doctor, this problem could progress to a more serious illness. When you go to the doctor, you will have to pay the copay — typically $30. Who pays the rest? The insurance company pays the doctor the difference between the copay you paid and the total charge.

They are separate:

The (copays) and (deductibles and coinsurance) are separate. If you are hospitalized, copays do not apply. You will pay your deductible and coinsurance.

On the other hand, if you go to see the doctor for a sick visit, you only pay a copay — no deductible and coinsurance involved here.

So, you can see that copays are very different from deductibles and coinsurance. You are probably happy, too, to learn that your copays are available to use immediately.