3

Pertaining to health insurance, what does "Copay with deductible" mean, in contrast to "Copay after deductible"?

I get "Copay after deductible" -- you must pay for the service fully out of pocket until your deductible is met, after which you must only pay the copay amount and the insurance pays for the rest.

So what does "Copay with deductible" mean?

enter image description here

2
  • New to this forum but wanted to reply to @BrandonLWhite on his comment to the last answer It sounds like "after" deductible would mean in your hypothetical, a $500 bill would have to be paid in full until the deductible is filled. Then after the deductible is completed, you would only have to pay the amount of the copay. "With" deductible would mean exactly as you describe – Tanner Dec 14 '18 at 14:22
  • 2
    I'm voting to close this question as off-topic because insurance is not medical science. – Carey Gregory Dec 14 '18 at 15:10
3

I've been looking at their plans too, and wondered the same thing. I called Sendero today at 844-800-4963 and the rep told me that it means the same thing as "after deductible". She said once you've reached your deductible, then you only pay the copay.

3

I had the same question and found the following on CMS.gov:

This cost-sharing option means the consumer first pays the copay, and any net remaining allowed charges accrue to the deductible.

2
  • +1: Hey @Forrest. Welcome to the site! I’ve allowed myself to edit your answer slightly to improve visibility (markdown is enables here, you might want to check that out for the future). If you oppose, feel free to revert the edit or edit the post yourself. For the time being, maybe you can edit your question to put further emphasis on the difference. (An example would at least help me). – Narusan Nov 13 '17 at 20:22
  • I must be dense, because that sounds like the same result as the Copay after deductible. Example: With zero deductible paid, you go to the specialist doctor. You pay $50 to the receptionist. Total bill is $500. You get a bill later for $450. You pay that. Can you explain the difference between "with" and "after" using this scenario? – BrandonLWhite Nov 14 '17 at 20:31

Not the answer you're looking for? Browse other questions tagged or ask your own question.