But copays really add up when you have ongoing health conditions.
And you may be wondering: Do copays count toward your health insurance deductible?
Does Your Copay Count Toward Your Deductible?
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How do you know for sure?
First, check yourSummary of Benefits and Coverage.
Pay close attention to the math in the examples.
But in general, you should expect that your copays will not be counted towards your deductible.
Lets say your health insurance is structured like this:
In January, youre diagnosed withdiabetes.
You see your PCP three times and are prescribed one generic drug and one brand-name drug.
You see the specialist and refill both of your prescriptions.
Your February copayments are $60 + $25 + $45 = $130.
You end up paying $240 for the tests, and that counts towards your deductible.
In March, you see the endocrinologist twice.
She changes your prescriptions; youre now on two brand-name drugs.
Your March copayments are $60 + $60 + $45 + $45 = $210.
(Note thatOriginal Medicarewithout supplemental coverageworks differently and does not have a cap on out-of-pocket charges.)
Most people don’t end up meeting their maximum out-of-pocket for the year.
Summary
As a general rule, copays do not count toward a health plan’s deductible.
Copays typically apply to some services while the deductible applies to others.
Centers for Medicare and Medicaid Services.Affordable Care Act Implementation FAQs Set 18.
