Case of The
'Never-Ending Copay'-Solved

The answer can be found in Chapter Three, under the Copay button.

Depending on how the plan is written, you may be required to pay a copay even if the out of pocket maximum has been met in full.

Think of a copay kind of like a service fee. Let's say your dishwasher breaks down and the service technician charges you $60.00 just to come to your house and diagnose the problem with the understanding that later you may be charged additional fees if you decide to have it repaired. Well, the copay can be thought of in the same sense. Nancy's plan requires that she pay a copay before she can even be seen by her doctor.

Do keep in mind that some health plans are written to include a separate out of pocket maximum just for copays. Once you have paid the stated amount, you will not have to pay another copay for the duration of the plan year. Nancy’s plan was clear, she will be required to pay the $20.00 at every visit.

Back to Case Study