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COBRA Insurance and Co-Payments

Posted on: March 5th, 2012 by Cobra Insurance Guide

cobra-insurance-copaymentsCOBRA insurance is a confusing topic and it can be difficult to sort through all the health insurance jargon and options available to you. This is made even more difficult for most people since they have just lost or quit their job. However, understanding your health insurance options, including COBRA insurance, doesn’t have to be difficult. Once you understand the basics and what you should be looking for, the decision will get much clearer and be much easier for you and your family.

One major part of this decision and a question we hear frequently from readers is the question of co-payments and how co-pays are affected by signing up for COBRA insurance. We are also often asked how co-payments should factor into a decision to choose a COBRA insurance alternative.

First, let’s look at exactly what a copay, or co-payment, actually is. A copay is an amount predetermined by the insurance company that you must pay up front for medical services. For example, you may have a copay of $25 for doctor visits, $50 for specialists visits, $100 for emergency room visits, $10 for generic prescriptions, and $20 for name brand prescriptions with your health insurance plan. Co-payments vary between insurance companies and between services. Once you pay the copay in most cases, the rest of the cost is covered by the health insurance company. Health insurance companies started using copays to share some of the medical cost and also to prevent unnecessary medical treatment .

For COBRA insurance, copays will remain exactly the same as they were when you were employed due to the fact that COBRA insurance simply continues the previous insurance that you had. That means that if you are used to paying $10 for all prescriptions, you will continue to pay $10 with COBRA insurance. If the health insurance co-payments change at your previous employer, they will also change for you.

When looking at alternative health insurance plans to COBRA insurance, which can cost over $10,000 annually for families, many people immediately shy away from any plan with high co-payments since they aren’t used to them. But in many cases, even if you take a higher copay cost, you can still save thousands of dollars by choosing a private insurance plan. Here’s how.

Let’s imagine that by signing up for COBRA insurance, your healthy family of four will spend $1000 a month for health insurance. Included in that plan are co-payments of $10 each for prescriptions and all doctor visits. On average your family visits the doctor 20 times a year and fills 5 prescriptions. (Likely your family visits the doctor MUCH less than this!) That means with COBRA insurance, you would pay $12,000 annually in premiums and an additional $250 on copays. That means your total COBRA insurance cost for the year is $12,250.

Now let’s imagine that your family finds a private health insurance plan that costs $425 monthly (based on the national average for insurance costs) but it comes with co-payments of $100 for prescriptions and doctor visits. This number is much higher than the national norm but will help show how much you can save even with high co-payments. Given your family visits the doctor 20 times annually and fills 5 prescriptions, you will spend a total of $2500 on copays. When we add that to the annual cost of the premium, $5,100, the total health insurance cost is $7,600. You are still saving $4,650 by using private health insurance!! And that is with extremely high co-payments and more doctor visits than most families have.

Want to find out how much you can save with private health insurance? Get a free, no obligation quote and compare that to the cost of COBRA insurance below.


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