Copayments, also known as copays, are a common feature in dental insurance plans. Copays are a fixed dollar amount that don’t change, no matter how much the dentist charges.
A copay, or copayment, is a preset amount you are required to pay before receiving a service or treatment covered by your dental insurance provider.
An example of a copayment is if you were to purchase dental coverage that comes with a co-pay of $15 for a teeth cleaning. In this case, when you make your appointment for a cleaning and exam, you can expect to pay your dentist $15 when you check in. If you go to a different dentist for a cleaning, $15 will also be due at the time you check in.
Copays are a single, predetermined amount that you pay before each treatment — and are due even after your deductible is reached.
Unlike copay’s fixed dollar amount, coinsurance is a percentage of the cost that you’re responsible for paying towards a dental treatment. Coinsurance levels can vary depending upon the specific treatment you get.
If your plan says that your filling comes with 50% coinsurance, that means the plan pays 50% of the cost to the dentist, and you pay the other 50%, after applying any deductible or required copay.
The deductible is the dollar amount you have to pay directly to your dentist before your benefits will begin. Your copay is the amount you pay to the for certain procedures dentist each time you visit.
Copays and deductibles don’t always apply on the same plan. When they do, the copay usually does not apply to the deductible. For example, Delta Dental’s Basic Plan has a copay of $15 for office visits, but no deductible. Other plans with deductibles do not have any copay responsibility.
In general, plans that have lower monthly premiums have higher deductibles. And plans with higher monthly premiums have lower deductibles.